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Real-world treatment results for ruptured blood-blister aneurysm of the internal carotid artery: analysis of a Japanese nationwide multicenter study

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Abstract

Ruptured blood-blister aneurysm (BBA) of the internal carotid artery (ICA) remains a challenging lesion, even in the age of modern neurosurgery and endovascular treatment. This retrospective multicenter study aimed to investigate the real-world treatment choice and treatment results. We included 182 ruptured BBAs of the ICA treated at 51 neurosurgical centers in Japan between 2013 and 2017. The baseline patient characteristics, radiological features of the aneurysm, treatment modality, details of treatment, complications of treatment, and treatment results were retrospectively collected. The treatment strategy was divided into deconstructive and reconstructive procedures. Primary clinical outcomes were evaluated using the modified Rankin scale (mRS) at final follow-up. Direct surgery was performed in 144 (79%) cases, and the remaining 38 (21%) cases received endovascular treatment. The majority of treatment selections were deconstructive and reconstructive procedures in the direct surgery group and endovascular treatment group, respectively. Overall, favorable clinical outcomes (mRS 0 to 2) were achieved in 66% of cases, and the mortality rate was 15% at the final follow-up (mean 23 months). There was no significant difference in clinical outcome between direct and endovascular treatment groups. Our large nationwide study compared the real-world treatment options for ruptured BBAs and their results. Our findings may offer beneficial information for treatment decision and for future studies investigating ruptured BBAs.

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Acknowledgements

We would like to express our gratitude to the following participating centers of this retrospective surveillance for kindly enrolling their cases: H. Shimizu, MD, Akita University Hospital; A. Fujikawa, MD, Chibaken Saiseikai Narashino Hospital; E. Ichihashi, MD, Chutoen General Medical Center; I. Nakahara, MD, Fujita Health University Hospital; H. Mukai, MD, Fukui Saiseikai Hospital; T. Tanigawara, MD, Gifu Municipal Hospital; H. Ohkuma, MD, Hirosaki University Hospital; K. Ogasawara, MD, Iwate Medical University Hospital; K. Takizawa, MD, Japanese Red Cross Asahikawa Hospital; K. Asakura, MD, Japanese Red Cross Maebashi Hospital; T. Haisa, MD, JR Tokyo General Hospital; T. Tamiya, MD, Kagawa University Hospital; H. Hadeishi, MD, Kameda Medical Center; S. Sato, MD, Kanazawa Neurosurgical Hospital; N. Sakai, MD, Kobe City Medical Center General Hospital; E. Kohmura, MD, Kobe University Hospital; S. Miyamoto, MD, Kyoto University Hospital; S. Haga, MD, Kyusyu Rosai Hospital; K. Akaji, MD, Mihara Memorial Hospital; T. Oikawa, MD, Minimisoma Municipal General Hospital; T. Izumo, MD, Nagasaki University Hospital; T. Izumi, MD, Nagoya University Hospital; T. Osato, MD, Nakamura Memorial Hospital; H. Nakase, MD, Nara Medical University Hospital; I. Date, MD, Okayama University Hospital; T. Nishida, MD, Osaka University Hospital; M. Indo, MD, Saitama Medical center, Saitama Medical University; N. Mikuni, MD, Sapporo Medical University Hospital; Y. Okumura, MD, Seikeikai Hospital; K. Nozaki, MD, Shiga University of Medical Science Hospital; K. Sakai, MD, Shinshu Ueda Medical Center; A. Matsuno, MD, Teikyo University Hospital; M. Hokari, MD, Teine Keijinkai Hospital; Y. Akiyama, MD, Tenri Hospital; Y. Takagi, MD, Tokushima University Hospital; T. Kawamata, MD, Tokyo Women’s University Hospital; H. Kasuya, MD, Tokyo Women’s Medical University Medical Center East; K. Kikuta, MD, University of Fukui Hospital; H. Ohta, MD, University of Miyazaki Hospital; S. Kuroda, MD, University of Toyama Hospital; Y. Matsumaru, MD, University of Tsukuba Hospital; H. Kinouchi, MD, University of Yamanashi Hospital; H. Okada, MD, Wakayama Rosal Hospital; R. Kondo, MD, Yamagata City Hospital Saiseikan; M. Morimoto, MD, Yokohamashintoshi Neurosurgical Hospital.

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Authors and Affiliations

  1. Department of Neurosurgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan

    Yusuke Egashira, Yukiko Enomoto, Noriyuki Nakayama & Toru Iwama

  2. Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan

    Miki Fujimura

  3. Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan

    Yuichiro Kikkawa

  4. Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

    Masanori Aihara

  5. Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan

    Takatoshi Sorimachi

  6. Department of Neurosurgery, Nippon Medical School, Chiba Hokuso Hospital, Inba, Chiba, Japan

    Takayuki Mizunari

Authors
  1. Yusuke Egashira
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  2. Yukiko Enomoto
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  3. Noriyuki Nakayama
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  4. Miki Fujimura
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  5. Yuichiro Kikkawa
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  6. Masanori Aihara
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  7. Takatoshi Sorimachi
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  8. Takayuki Mizunari
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  9. Toru Iwama
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Contributions

Study conception and design: Iwama, Egashira, Enomoto, and Nakayama. Drafting the article: Egashira. Revising the manuscript critically for important intellectual content: All authors. Acquisition of data: All authors. Analysis and interpretation of data: All authors. Study supervision: Iwama. Final approval of the version to be submitted: All authors.

Corresponding author

Correspondence to Yusuke Egashira.

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Ethics approval

All study protocols were approved by the Institutional Review Board of the Gifu University Graduate School of Medicine.

Consent to participate

Given that the design of this study was noninvasive and retrospective, the requirement for informed written consent from included patients was waived.

Consent for publication

Given that the design of this study was noninvasive and retrospective, the requirement for informed written consent from included patients was waived.

Conflict of interest

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Egashira, Y., Enomoto, Y., Nakayama, N. et al. Real-world treatment results for ruptured blood-blister aneurysm of the internal carotid artery: analysis of a Japanese nationwide multicenter study. Neurosurg Rev 44, 3539–3546 (2021). https://doi.org/10.1007/s10143-021-01542-0

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  • DOI: https://doi.org/10.1007/s10143-021-01542-0

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