Abstract
Treatment of blood blister-like aneurysms (BBAs) of the supraclinoidal internal carotid artery (ICA) is challenging and the optimal treatment is yet to be defined. The treatment options for ICA BBAS are microsurgery, endovascular therapy, or a combination of the two. The microsurgical armamentarium consists mainly of direct aneurysm clipping with or without protective EC-IC bypass, clip-wrapping, or trap ligation with ICA sacrifice with or without EC-IC bypass. The endovascular treatment options are mainly endovascular ICA ligation, multiple overlapping stents (≥ 3) with or without coiling, covered stents, or flow diverters. In four recent meta-analyses of BBAs, neither microsurgical nor endovascular therapy had an impact on clinical outcome in multivariate analysis. Microsurgery offered aneurysm obliteration rates superior to endovascular techniques, but came at a higher risk of intraoperative bleeding. Endovascular therapy increased the likelihood of a second treatment, conversion to another treatment modality, and incomplete aneurysm obliteration. In this review, we discuss pros and cons of the above approaches while adding our own viewpoints to the discussion.
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Aydin K, Arat A, Sencer S, Hakyemez B, Barburoglu M, Sencer A, Izgi N (2014) Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointervent Surg 7:202–209. doi:10.1136/neurintsurg-2013-011090
Bojanowski MW, Weil AG, McLaughlin N, Chaalala C, Magro E, Fournier J-Y (2015) Morphological aspects of blister aneurysms and nuances for surgical treatment. J Neurosurg 123:1156–1165. doi:10.3171/2014.11.JNS141004
Charbel FT, Gonzales-Portillo G, Hoffman W, Cochran E (1999) Distal internal carotid artery pseudoaneurysms: technique and pitfalls of surgical management: two technical case reports. Neurosurgery 45:643–648 discussion 648-649
Fang C, Tan HQ, Han HJ, Feng H, Xu JC, Yan S, Nie ZY, Jin LJ, Teng F (2016) Endovascular isolation of intracranial blood blister-like aneurysms with Willis covered stent. J Neurointervent Surg. doi:10.1136/neurintsurg-2016-012662
Fang YB, Li Q, Yang PF, Huang QH, Zhao WY, Xu Y, Hong B, Liu JM (2012) Treatment of blood blister-like aneurysms of the internal carotid artery with stent-assisted coil embolization. Clin Neurol Neurosurg 115:920–925. doi:10.1016/j.clineuro.2012.09.022
Gaughen JR Jr, Hasan D, Dumont AS, Jensen ME, McKenzie J, Evans AJ (2010) The efficacy of endovascular stenting in the treatment of supraclinoid internal carotid artery blister aneurysms using a stent-in-stent technique. AJNR Am J Neuroradiol 31:1132–1138. doi:10.3174/ajnr.A2016
Gaughen JR Jr, Raghavan P, Jensen ME, Hasan D, Pfeffer AN, Evans AJ (2010) Utility of CT angiography in the identification and characterization of supraclinoid internal carotid artery blister aneurysms. AJNR Am J Neuroradiol 31:640–644. doi:10.3174/ajnr.A1893
Gonzalez AM, Narata AP, Yilmaz H, Bijlenga P, Radovanovic I, Schaller K, Lovblad KO, Pereira VM (2014) Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol 83:197–205. doi:10.1016/j.ejrad.2013.09.017
Ishikawa T, Nakamura N, Houkin K, Nomura M (1997) Pathological consideration of a "blister-like" aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery 40:403–406
Joo SP, Kim TS, Moon KS, Kwak HJ, Lee JK, Kim JH, Kim SH (2006) Arterial suturing followed by clip reinforcement with circumferential wrapping for blister-like aneurysms of the internal carotid artery. Surg Neurol 66:424–428
Kalani MY, Albuquerque FC, Levitt M, Nakaji P, Spetzler RF, McDougall C (2015) Pipeline embolization for definitive endoluminal reconstruction of blister-type carotid aneurysms after clip wrapping. J Neurointervent Surg 8:495–500. doi:10.1136/neurintsurg-2015-011659
Kalani MY, Zabramski JM, Kim LJ, Chowdhry SA, Mendes GA, Nakaji P, McDougall CG, Albuquerque FC, Spetzler RF (2013) Long-term follow-up of blister aneurysms of the internal carotid artery. Neurosurgery 73:1026–1033; discussion 1033. doi:10.1227/NEU.0000000000000147
Kamijo K, Matsui T (2010) Acute extracranial-intracranial bypass using a radial artery graft along with trapping of a ruptured blood blister-like aneurysm of the internal carotid artery. Clinical article. J Neurosurg 113:781–785. doi:10.3171/2009.10.JNS09970
Kazumata K, Nakayama N, Nakamura T, Kamiyama H, Terasaka S, Houkin K (2014) Changing treatment strategy from clipping to radial artery graft bypass and parent artery sacrifice in patients with ruptured blister-like internal carotid artery aneurysms. Neurosurgery 10(Suppl 1):66–72; discussion 73. doi:10.1227/NEU.0000000000000076
Kikkawa Y, Ikeda T, Takeda R, Nakajima H, Ogura T, Ooigawa H, Kurita H (2017) Results of early high-flow bypass and trapping for ruptured blood blister-like aneurysms of the internal carotid artery. World Neurosurg. doi:10.1016/j.wneu.2017.06.033
Kim BC, Kwon OK, Oh CW, Bang JS, Hwang G, Jin SC, Park H (2014) Endovascular internal carotid artery trapping for ruptured blood blister-like aneurysms: long-term results from a single centre. Neuroradiology 56:211–217. doi:10.1007/s00234-014-1317-3
Konczalla J, Gessler F, Bruder M, Berkefeld J, Marquardt G, Seifert V (2017) Outcome after subarachnoid hemorrhage from blood blister-like aneurysm rupture depends on age and aneurysm morphology. World Neurosurg. doi:10.1016/j.wneu.2017.06.129
Lee JW, Choi HG, Jung JY, Huh SK, Lee KC (2009) Surgical strategies for ruptured blister-like aneurysms arising from the internal carotid artery: a clinical analysis of 18 consecutive patients. Acta Neurochir 151:125–130. doi:10.1007/s00701-008-0165-5
Lim YC, Kim BM, Suh SH, Jeon P, Kim SH, Ihn YK, Lee YJ, Sim SY, Chung J, Kim DJ, Kim DI (2013) Reconstructive treatment of ruptured blood blister-like aneurysms with stent and coil. Neurosurgery 73:480–488. doi:10.1227/neu.0000000000000005
Linfante I, Mayich M, Sonig A, Fujimoto J, Siddiqui A, Dabus G (2016) Flow diversion with Pipeline embolic device as treatment of subarachnoid hemorrhage secondary to blister aneurysms: dual-center experience and review of the literature. J Neurointervent Surg 9:29–33. doi:10.1136/neurintsurg-2016-012287
McLaughlin M, Laroche M, Bojanowski MW (2010) Surgical management of blood blister–like aneurysms of the internal carotid artery. World Neurosurg 74:483–493. doi:10.1016/j.wneu.2010.06.039
Meling TR, Sorteberg A, Bakke SJ, Slettebo H, Hernesniemi J, Sorteberg W (2008) Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg 108:662–671. doi:10.3171/JNS/2008/108/4/0662
Nakagawa F, Kobayashi S, Nagamine Y, Yanagida N, Mikawa S, Suzuki A (1986) Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 65:303–308
Ogawa A, Suzuki A, Ogasawara K (2000) Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery: internal carotid trunk aneurysms. Neurosurgery 47:578–586
Otani N, Takasato Y, Masaoka H, Hayakawa T, Yoshino Y, Yatsushige H, Sumiyoshi K, Miyawaki H, Aoyagi C, Takeuchi S, Suzuki G (2009) Clinical and radiological findings and surgical management of ruptured aneurysms at the non-branching sites of the internal carotid artery. J Clin Neurosci 16:1018–1023. doi:10.1016/j.jocn.2008.05.025
Owen CM, Montemurro N, Lawton MT (2017) Blister aneurysms of the internal carotid artery: microsurgical results and management strategy. Neurosurgery 80:235–247. doi:10.1227/NEU.0000000000001259
Pahl FH, de Oliveira MF, Teles Gomes Mde Q, Capel Cardoso AC, Rotta JM (2016) Blister-like aneurysms: report of successful surgical treatment of consecutive cases and review of the literature. World Neurosurg 89:376–381. doi:10.1016/j.wneu.2016.01.025
Park JH, Park IS, Han DH, Kim SH, Oh CW, Kim JE, Kim HJ, Han MH, Kwon OK (2007) Endovascular treatment of blood blister-like aneurysms of the internal carotid artery. J Neurosurg 106:812–819
Peschillo S, Cannizzaro D, Caporlingua A, Missori P (2016) A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms. AJNR Am J Neuroradiol 37:856–861. doi:10.3174/ajnr.A4606
Rouchaud A, Brinjikji W, Cloft HJ, Kallmes DF (2015) 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 36(12):2331–2339. doi:10.3174/ajnr.A4438
Safavi-Abbasi S, Moron F, Sun H, Oppenlander ME, Kalani MY, Mulholland CB, Zabramski JM, Nakaji P, Spetzler RF (2016) Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms. J Neurosurg 125:720–729. doi:10.3171/2015.7.JNS151165
Safavi-Abbasi S, Moron F, Sun H, Wilson C, Frock B, Oppenlander ME, Xu DS, Ghafil C, Zabramski JM, Spetzler RF, Nakaji P (2016) Techniques and outcomes of Gore-Tex clip-wrapping of ruptured and Unruptured cerebral aneurysms. World Neurosurg 90:281–290. doi:10.1016/j.wneu.2016.02.109
Shah SS, Gersey ZC, Nuh M, Ghonim HT, Elhammady MS, Peterson EC (2017) Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery: systematic review of literature and meta-analysis on safety and efficacy. J Neurosurg 1–13. doi:10.3171/2016.9.jns161526
Shigeta H, Kyoshima K, Nakagawa F, Kobayashi S (1992) Dorsal internal carotid artery aneurysms with special reference to angiographic presentation and surgical management. Acta Neurochir 119:42–48
Sim SY, Shin YS, Cho KG, Kim SY, Kim SH, Ahn YH, Yoon SH, Cho KH (2006) Blood blister-like aneurysms at nonbranching sites of the internal carotid artery. J Neurosurg 105:400–405
Song J, Oh S, Kim MJ, Chung J, Lim YC, Kim BS, Shin YS (2016) Endovascular treatment of ruptured blood blister-like aneurysms with multiple (>/=3) overlapping Enterprise stents and coiling. Acta Neurochir 158:803–809. doi:10.1007/s00701-016-2721-8
Sorteberg A (2014) Balloon occlusion tests and therapeutic vessel occlusions revisited: when, when not, and how. AJNR Am J Neuroradiol 35:862–865. doi:10.3174/ajnr.A3852
Sorteberg A, Sorteberg W, Bakke SJ, Lindegaard KF, Boysen M, Nornes H (1997) Cerebral haemodynamics in internal carotid artery trial occlusion. Acta Neurochir 139:1066–1073
Szmuda T, Sloniewski P, Waszak PM, Springer J, Szmuda M (2015) Towards a new treatment paradigm for ruptured blood blister-like aneurysms of the internal carotid artery? A rapid systematic review. J Neurointervent Surg 8:488–494. doi:10.1136/neurintsurg-2015-011665
Yu J, Xu B, Guo Y, Xu K (2016) Direct clipping of a blister-like aneurysm in the supraclinoid segment of the internal carotid artery: a clinical analysis of nine cases. Int J Clin Exp Med 8:21786–21795
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Meling, T.R. What are the treatment options for blister-like aneurysms?. Neurosurg Rev 40, 587–593 (2017). https://doi.org/10.1007/s10143-017-0893-1
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DOI: https://doi.org/10.1007/s10143-017-0893-1