NDLI: Rupture of symptomatic blood blister-like aneurysm of the internal carotid artery: clinical experience and management outcome.

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Rupture of symptomatic blood blister-like aneurysm of the internal carotid artery: clinical experience and management outcome.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Yu-Tse, Liu Ho-Fai, Wong Cheng-Chi, Lee Chu-Mei, Ku Yi-Chou, Wang Tao-Chieh, Yang
Description	Country affiliation: China Author Affiliation: Yu-Tse L ( Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China.)
Abstract	BACKGROUND: Aneurysms at nonbranching sites in the supraclinoid internal carotid artery (ICA), known as blood blister-like aneurysms (BBAs), are rare entities and differ from saccular aneurysms. In this study, we attempt to describe our clinical experience and the outcome of treatments for BBAs. METHOD: Thirteen of 745 patients with aneurysmal subarachnoid hemorrhage (SAH) who visited our institution between March 2005 and July 2010, and were confirmed to have BBAs at nonbranching sites of the supraclinoid ICA by digital subtraction angiography (DSA) or computed tomography angiography, were followed-up. In these patients, several therapeutic managements were provided depending on their clinical condition. Data analyzed included patient age, sex, World Federation of Neurologic Surgeons (WFNS) scale, time interval from first DSA to second DSA, treatment of aneurysms, and the modified Rankin scale score at follow-up, 6 months after SAH. RESULT: Of these 13 patients, 5 underwent rapid configuration change from blood blister-like aneurysm to saccular-shaped. Different therapeutic managements were provided, including clipping on wrapping material in 2 patients, ICA trapping without extracranial-intracranial (EC-IC) bypass in 3 patients, EC-IC bypass and ICA trapping in 3 patients, transarterial endovascular therapy in 3 patients, direct clipping in 1 patient, and external ventricular drainage in 1 patient. Good clinical outcome was achieved in 4 patients, whereas the other 9 patients had moderate to severe disability due to rebleeding of aneurysms, large cerebral infarction, or severe cerebral vasospasm. CONCLUSIONS: BBAs of the supraclinoid ICA have special neuroradiological and clinicopathological characteristics. Direct clipping or endovascular coil embolization along may not be sufficient and sometimes have undesirable results. ICA trapping or ligation including the lesion segment can be considered an alternative choice if the balloon occlusion test (BOT) is successful. However, if the patient does not tolerate the BOT, EC-IC bypass surgery with ICA ligation or trapping is another option.
File Format	HTM / HTML
ISSN	02688697
Issue Number	3
Volume Number	26
e-ISSN	1360046X
Journal	British Journal of Neurosurgery
Language	English
Publisher	Taylor & Francis
Publisher Date	2012-06-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Neurosurgery Aneurysm, Ruptured Surgery Carotid Artery Diseases Carotid Artery, Internal Intracranial Aneurysm Aged Blister Cerebral Angiography Methods Female Humans Male Middle Aged Tomography, X-ray Computed Journal Article
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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