Clip-wrapping of ruptured blood blister-like aneurysms of the internal carotid artery
- PDF / 2,528,086 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 30 Downloads / 190 Views
ORIGINAL ARTICLE
Clip-wrapping of ruptured blood blister-like aneurysms of the internal carotid artery Torstein R. Meling 1,2,3,4
&
Gildas Patet 1
Received: 16 July 2019 / Revised: 18 August 2019 / Accepted: 27 August 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract To evaluate the safety and validity of microsurgical Gore-Tex clip-wrapping for ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA). Single-surgeon series. Retrospective study. Data analyzed were patient age, sex, Hunt and Hess grade (H&H), Fisher grade, time from rupture to hospitalization, aneurysm size and location, collateral capacity of the circle of Willis, time from hospitalization to aneurysm repair, aneurysm obliteration, complications, and modified Rankin scale (mRS) at follow-up. Six patients (2 males, 4 females) with ICA BBAs underwent clip-wrapping between 2011 and 2016. Median age was 50.0 years (range 31.7–54.0). H&H was grade 1 or 2 in 5 patients and grade 4 in 1 patient. All aneurysms were small (≤ 0.3 cm), without relation to vessel bifurcations, and located anteromedially, anterolaterally, and superomedially on the ICA trunk. Right side was most frequent (66%). All aneurysms could be clip-wrapped without intraoperative ruptures and all parent arteries could be preserved in the acute phase. Clip-wrapping completely eliminated the BBAs in five patients, whereas one patient underwent additional stent-assisted coiling. There were no re-ruptures, delayed infarctions, or deaths postoperatively. After a median followup of 57 months (range 20–90), outcome was favorable (mRS score 0–2) in all patients without radiographic signs of recurrences. Using the Gore-Tex clip-wrapping technique for ruptured ICA BBAs, the aneurysm could be treated without intraoperative ruptures or parent artery sacrifice in the acute phase. The outcomes were similar to other SAH patients and on follow-up, there were no aneurysm recurrences, indicating a durable long-term outcome. Keywords Aneurysm . Blood blister-like aneurysm . Internal carotid artery . Subarachnoid hemorrhage
Introduction Blood blister-like aneurysms (BBAs) are a rare subtype of intracranial pseudoaneurysmal lesions that account for 0.5–2% of ruptured intracranial aneurysms and result in abnormally high morbidity and mortality [1–3]. They represent approximately 0.9–6.5% of all internal carotid artery (ICA) aneurysms [3, 4]. Unlike saccular or “berry”
* Torstein R. Meling [email protected] 1
Service de Neurochirurgie, Hôpitaux Universitaires de Genève, Rue Gabriel-Perret-Gentil 5, 1205 Geneva, Switzerland
2
Faculty of Medicine, University of Geneva, Geneva, Switzerland
3
Faculty of Medicine, University of Oslo, Oslo, Norway
4
Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
aneurysms, which usually occur at branch points, BBAs are small and characterized by a broad-based bulge at non-branching sites on arteries [5]. Although they can occur almost anywhere, they most commonly arise from the superior or sup
Data Loading...
