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Endovascular coil embolization for saccular-shaped blood blister-like aneurysms of the internal carotid artery

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Abstract

Background

Because of their fragile and thin wall, ruptured blood blister-like aneurysms (BBAs) at the anterior wall of the internal carotid artery (ICA) are difficult to manage, both surgically, as well as endovascularly. BBA is usually a tiny and broad-necked aneurysm, but it occasionally demonstrates a relatively saccular-like shape. In addition, the pseudoaneurysm sac often assumes a saccular shape. In this paper, the authors present their experience in treating these saccular-shaped BBAs endovascularly with coil packing.

Method

Nine saccular-shaped ruptured BBAs in nine patients (one male and eight females; mean age 51.3 years, range 38–76) were treated with coil packing of the lesion between January 2006 and August 2010 in Nagoya University and its affiliated hospitals. Clinical, procedural, and angiographic data were retrospectively evaluated.

Findings

Seven BBAs were treated by balloon-assisted coil embolization. Two remaining BBAs were embolized without balloon inflation, though a balloon catheter was on standby at the ICA. In one case, in which a saccular coil embolization could not be achieved, ICA trapping was performed. Three (33.3%) were treated in acute, two (22.2%) in subacute, and four (44.4%) in chronic period. One (11.1%) intraoperative rupture occurred. Six (66.7%) had excellent clinical outcomes, while two (22.2%) proved fatal outcomes. During the follow-up period (mean 18.9 months, range 4–48), two out of seven (28.6%) aneurysms presented an angiographical recurrence, but both were treated by coil embolization without complications. The remaining five (71.4%) aneurysms were completely resolved.

Conclusions

Endovascular coil embolization can be considered as an alternative treatment option for selective saccular-shaped BBAs.

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Abbreviations

AchoA:

anterior choroidal artery

BBA:

blood blister-like aneurysm

CT:

computed tomography

GOS:

Glasgow Outcome Scale

ICA:

internal carotid artery

MRA:

MR angiogram

PcomA:

posterior communicating artery

SAH:

subarachnoid hemorrhage

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Acknowledgments

The authors wish to thank Takeshi Okamoto, M.D. of the Japanese Red Cross, Nagoya Daiichi Hospital, and Takeshi Kinkori, M.D. of the Okazaki Municipal Hospital for their generous support during this study.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan

    Noriaki Matsubara, Shigeru Miyachi, Takashi Izumi, Takehiro Naito, Kenichi Haraguchi & Toshihiko Wakabayashi

  2. Department of Neurosurgery, Hekinan Municipal Hospital, Hekinan, Aichi, Japan

    Noriaki Matsubara & Nobuhiro Tsukamoto

Authors
  1. Noriaki Matsubara
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  2. Shigeru Miyachi
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  3. Nobuhiro Tsukamoto
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  4. Takashi Izumi
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  5. Takehiro Naito
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  6. Kenichi Haraguchi
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  7. Toshihiko Wakabayashi
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Correspondence to Shigeru Miyachi.

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Matsubara, N., Miyachi, S., Tsukamoto, N. et al. Endovascular coil embolization for saccular-shaped blood blister-like aneurysms of the internal carotid artery. Acta Neurochir 153, 287–294 (2011). https://doi.org/10.1007/s00701-010-0898-9

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  • DOI: https://doi.org/10.1007/s00701-010-0898-9

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