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Reconstructive Treatment of Ruptured Blood Blister-like Aneurysms With Stent and Coil

Authors
Lim, Yong CheolKim, Byung MoonSuh, Sang HyunJeon, PyoungKim, Sang HeumIhn, Yon-KwonLee, Young-JunSim, Sook YoungChung, JoonhoKim, Dong JoonKim, Dong Ik
Issue Date
Sep-2013
Publisher
OXFORD UNIV PRESS INC
Keywords
Blood blister-like aneurysm; Outcomes; Stent-assisted coiling
Citation
NEUROSURGERY, v.73, no.3, pp.480 - 488
Indexed
SCIE
SCOPUS
Journal Title
NEUROSURGERY
Volume
73
Number
3
Start Page
480
End Page
488
URI
https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/162081
DOI
10.1227/NEU.0000000000000005
ISSN
0148-396X
Abstract
BACKGROUND: Controversy remains about the optimal treatment for blood blister-like aneurysms (BBAs). OBJECTIVE: To evaluate clinical and angiographic outcomes after reconstructive treatment for BBA with stent and coil. METHODS: Thirty-four patients (6 men, 28 women; mean age, 47.3 years) with ruptured BBAs underwent reconstructive treatment with stent and coil. Posttreatment courses and outcomes were retrospectively evaluated. RESULTS: Initial treatments were >= 2 overlapping stents with or without coiling (n = 28) and single stent with coiling (n = 6). Three BBAs rebled on days 9, 11, and 15 after treatment, resulting in 1 death. Except for 3 patients who died early, 31 patients were followed up for 7 to 80 months (median, 32 months). One patient recovered completely but died of complications of systemic lupus erythematosus at 25 months. Of the remaining 30 patients, 25 had favorable outcomes (modified Rankin scale, 0-2) and 5 had unfavorable outcomes. Angiographic follow-up was available in the 32 BBAs. Eight (25.0%) recurred, all within 5 weeks. In the multiple stents group (n = 26), 22 BBAs showed improvement or complete healing, but 4 (15.4%, 2 rebleedings) had recurrence. In the single stent with coiling group (n = 6), 2 BBAs were stable but 4 (66.7%, 1 rebleeding) had recurrence. Single stent with coiling and Hunt and Hess grade >= 4 were 2 independent risk factors for recurrence (P < .05). CONCLUSION: Reconstructive treatment with stent and coil appears a viable option for BBAs. Single stent with coiling and Hunt and Hess grade >= 4 were 2 independent risk factors for recurrence. Follow-up angiography should be considered mandatory soon after treatment.
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