Abstract
A 48-year-old female patient presented with a headache and nuchal stiffness which had been present for a week and with paresthesia of the left side which had been present for a day. The patient had been treated for a paraophthalmic aneurysm of the left ICA with flow diversion 12 months prior. Non-contrast cranial CT (NCCT) was within normal limits. Lumbar puncture showed xanthrochromic cerebrospinal fluid (CSF) in accordance with a recent subarachnoid hemorrhage (SAH). On day 7 after the clinical onset, a DSA revealed a blister aneurysm of the paraophthalmic segment of the right internal carotid artery (ICA), directed cranially and with a neck diameter of 2.5 mm. This blister aneurysm was considered to be the most likely source of the SAH. Dual platelet function inhibition was induced during the following endovascular procedure using acetylsalicylic acid (ASA), ticagrelor, and eptifibatide. A p64 flow diverter stent was implanted into the paraophthalmic segment of the right ICA, covering the blister aneurysm. This procedure was well tolerated and a follow-up DSA three months later confirmed the blister aneurysm had been obliterated. The flow diverter treatment of ruptured blister aneurysms of the anterior circulation during the acute post-SAH phase is the main topic of this chapter.
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References
Aydin K, Arat A, Sencer S, Hakyemez B, Barburoglu M, Sencer A, İzgi N. Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg. 2015;7(3):202–9. https://doi.org/10.1136/neurintsurg-2013-011090.
Chalouhi N, Zanaty M, Tjoumakaris S, Gonzalez LF, Hasan D, Kung D, Rosenwasser RH, Jabbour P. Treatment of blister-like aneurysms with the pipeline embolization device. Neurosurgery. 2014;74(5):527–32. https://doi.org/10.1227/NEU.0000000000000309; discussion 532.
Chinchure SD, Gupta V, Goel G, Gupta A, Jha A. Subarachnoid hemorrhage with blister aneurysms: endovascular management. Neurol India. 2014;62(4):393–9. https://doi.org/10.4103/0028-3886.141262.
Hanel RA, Aguilar-Salinas P, Brasiliense LB, Sauvageau E. First US experience with Pipeline Flex with Shield Technology using aspirin as antiplatelet monotherapy. BMJ Case Rep. 2017;2017:pii: bcr-2017-219406. https://doi.org/10.1136/bcr-2017-219406.
Ji T, Guo Y, Huang X, Xu B, Xu K, Yu J. Current status of the treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery: a review. Int J Med Sci. 2017;14(4):390–402. https://doi.org/10.7150/ijms.17979.
Linfante I, Mayich M, Sonig A, Fujimoto J, Siddiqui A, Dabus G. Flow diversion with Pipeline Embolic Device as treatment of subarachnoid hemorrhage secondary to blister aneurysms: dual-center experience and review of the literature. J Neurointerv Surg. 2017;9(1):29–33. https://doi.org/10.1136/neurintsurg-2016-01228.
Mazur MD, Taussky P, MacDonald JD, Park MS. Rerupture of a blister aneurysm after treatment with a single flow-diverting stent. Neurosurgery. 2016;79(5):E634–8.
Meling TR. What are the treatment options for blister-like aneurysms? Neurosurg Rev. 2017;40(4):587–93. https://doi.org/10.1007/s10143-017-0893-1.
Nerva JD, Morton RP, Levitt MR, Osbun JW, Ferreira MJ, Ghodke BV, Kim LJ. Pipeline Embolization Device as primary treatment for blister aneurysms and iatrogenic pseudoaneurysms of the internal carotid artery. J Neurointerv Surg. 2015;7(3):210–6. https://doi.org/10.1136/neurintsurg-2013-011047.
Nishikawa H, Shimizu S, Nakajima H, Kitano Y, Sano T, Mouri G, Miya F, Suzuki H. Characteristics of blood blister-like aneurysms with a saccular-shape appearance. World Neurosurg. 2017;108:595–602. https://doi.org/10.1016/j.wneu.2017.09.054.
Peschillo S, Cannizzaro D, Caporlingua A, Missori P. A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms. AJNR Am J Neuroradiol. 2016;37(5):856–61. https://doi.org/10.3174/ajnr.A4606.
Rouchaud A, Brinjikji W, Cloft HJ, Kallmes DF. Endovascular treatment of ruptured blister-like aneurysms: a systematic review and meta-analysis with focus on deconstructive versus reconstructive and flow-diverter treatments. AJNR Am J Neuroradiol. 2015;36(12):2331–9. https://doi.org/10.3174/ajnr.A4438.
Ryan RW, Khan AS, Barco R, Choulakian A. Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy. Neurosurg Focus. 2017;42(6):E11. https://doi.org/10.3171/2017.3.FOCUS1757.
Yoon JW, Siddiqui AH, Dumont TM, Levy EI, Hopkins LN, Lanzino G, Lopes DK, Moftakhar R, Billingsley JT, Welch BG, Boulos AS, Yamamoto J, Tawk RG, Ringer AJ, Hanel RA, Endovascular Neurosurgery Research Group. Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms. Neurosurgery. 2014;75(4):419–29. https://doi.org/10.1227/NEU.0000000000000487; discussion 429.
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Hellstern, V., Aguilar Pérez, M., AlMatter, M., Henkes, H. (2020). Paraophthalmic Internal Carotid Artery Aneurysm: Spontaneous Subarachnoid Hemorrhage, Blood Blister Aneurysm, Flow Diverter Treatment During the Acute Phase. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-77827-3_40
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