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Flow diverter treatment of cerebral blister aneurysms

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Blood blister-like aneurysms (BBA) are small, friable, broad-based aneurysms that represent high risk for rerupture. Treatment of BBA is challenging, and may include surgical wrapping, clipping, multiple overlapping stents, and/or coiling. Flow diversion is a rapidly evolving treatment strategy for intracranial aneurysms, but the evidence for its use in cases of BBA is scarce.

Methods

A retrospective review of flow-diverter-treated, ruptured BBA cases at our tertiary care institution was undertaken. Clinical, imaging, procedural, and mid-term follow-up data on the patients were collected.

Results

Eight patients underwent flow-diverter stent treatment for ruptured BBA. Median age at time of treatment was 49 years (interquartile range [IQR] 42–57) with five females (62.5%). The most common location of the BBA was the supraclinoid segment of the internal carotid artery. The median Hunt-Hess score was 2 (IQR 1.7–3.2). All patients were treated with dual anti-platelet therapy. Good clinical outcomes (modified Rankin score 0–2) were seen in 6/7 (85.7%) patients with available follow-up at 1 year. Complete occlusion of the aneurysm on latest angiogram (7) or MRI (1) was seen in 6/8 (75%) patients (at a median of 8 months). No patient had rerupture, retreatment, or recurrence of the aneurysm.

Conclusion

Flow-diverter stents may be a feasible treatment option for BBAs. They offer high occlusion and low retreatment rates with good mid-term outcomes, but the long-term efficacy remains unknown. Also, dual anti-platelet therapy in the acute ruptured setting can be challenging.

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Authors and Affiliations

  1. Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Ave, S80, Cleveland, OH, 44195, USA

    Russell Cerejo, Mark Bain, Seby John, Julian Hardman, Nina Moore, M. Shazam Hussain & Gabor Toth

Authors
  1. Russell Cerejo
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  2. Mark Bain
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  3. Seby John
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  4. Julian Hardman
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  5. Nina Moore
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  6. M. Shazam Hussain
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  7. Gabor Toth
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Corresponding author

Correspondence to Gabor Toth.

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Funding

No funding was received for this study.

Conflict of interest

MB consults for Codman and Stryker and is on the Clinical Events Committee for the BARREL trial. MSH is on the Clinical Events Committee for Pulsar Inc. GT is on the Data Safety Monitoring Board for the COMPASS trial.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants or their legal representatives included in the study.

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Cerejo, R., Bain, M., John, S. et al. Flow diverter treatment of cerebral blister aneurysms. Neuroradiology 59, 1285–1290 (2017). https://doi.org/10.1007/s00234-017-1936-6

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  • DOI: https://doi.org/10.1007/s00234-017-1936-6

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