Original Article
Effects of surgical and endovascular treatment of blood blister-like aneurysms of the internal carotid artery
Li Jin, Sun Hong, Xie Xiaodong, He Min, You Chao
Published 2017-08-01
Cite as Chin J Surg, 2017, 55(8): 613-617. DOI: 10.3760/cma.j.issn.0529-5815.2017.08.012
Abstract
ObjectiveTo explore the clinical characteristics, therapeutic methods and effects of blood blister-like aneurysms (BBA) of the supraclinoid segment of the internal carotid artery (ICA).
MethodsA total of 40 patients with BBAs of the ICA treated at Department of Neurosurgery of West China Hospital between January 2010 and January 2016 were retrospectively reviewed. There were 14 males and 26 females with the mean age of 44.7 years (ranging from 25 to 64 years). There were 38 patients presented with subarachnoid hemorrhage (SAH), and 2 patients were found incidentally with unruptured aneurysms in regular examination. Surgical treatment was performed in 22 patients, including direct clipping, clipping over wrapping and trapping. Endovascular treatment with single or multiple stents and coiling was performed in 18 patients. Clinical outcomes were assessed with modified Rankin Scale. The patients were followed up with CT angiography.
ResultsDirect clipping of BBA was performed in 18 patients, clipping over wrapping in 3 patients and trapping of ICA in 1 patient. Intraoperative rupture occurred in 5 patients. Postoperative cerebral infarction developed in 6 cases, 4 patients died. Single stent-assisted coiling was performed in 8 cases, and multiple stents with coiling in 10 patients. Procedure-related hemorrhage occurred in 2 patients, postoperative massive cerebral infarction developed in 1 patient with stent-assisted coiling. The follow-up time was 26.8 months (ranging from 6 to 72 months), among the patients with surgery, good results (modified Rankin Scale 0-2) were achieved in 16 patients; one patient was score 3, and the other was 4. In endovascular group, 15 patients had good results and one with mRS 4. Follow-up angiography revealed recurrence of BBA in 2 patients treated with stent and coiling, which was retreated with coiling. No recurrence was found in surgical group.
ConclusionsBBA of the supraclinoid ICA is a specific and complicated intracranial aneurysm with high risk and complications no matter the treatment is surgical or endovascular, take proper operation methods could achieve satisfactory results.
Key words:
Intracranial aneurysm; Neurosurgical procedures; Endovascular treatment; Stents
Contributor Information
Li Jin
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
Sun Hong
Xie Xiaodong
He Min
You Chao
