Long-term follow-up analysis of microsurgical clip ligation and endovascular coil embolization for dorsal wall blister aneurysms of the internal carotid artery.

Autor: Brown MA; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States., Guandique CF; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States., Parish J; Carolinas HealthCare System, Charlotte, NC, United States., McMillan AC; Boston University School of Medicine, Boston, MA, United States., Lehnert S; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States., Mansour N; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States., Tu M; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States., Bohnstedt BN; Department of Neurosurgery, University Health Sciences Center, Oklahoma City, OK, United States., Payner TD; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States., Leipzig TJ; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States., DeNardo AJ; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States., Scott JA; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States., Cohen-Gadol AA; Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2017 May; Vol. 39, pp. 72-77. Date of Electronic Publication: 2017 Jan 11.
DOI: 10.1016/j.jocn.2016.12.021
Abstrakt: Blister aneurysms at non-branching sites of the dorsal internal carotid artery (dICA) are fragile, rare, and often difficult to treat. The purpose of this study is to address the demographics, treatment modalities, and long-term outcome of patients treated for dICA blister aneurysms. A retrospective review of medical records identified all consecutive patients who presented with a blister aneurysm from 2002 to 2011 at our institution. Eighteen patients (M=7, F=11; mean age: 48.4±15.1years; range: 15-65years) harbored a total of 43 aneurysms, 25 of which were dorsal wall blister aneurysms of the ICA. Eleven (61.1%) patients presented with aneurysmal subarachnoid hemorrhage (aSAH), and 10 (55.6%) patients had multiple aneurysms at admission. Twelve patients had 18 aneurysms that were treated microsurgically. Five (41.7%) of these patients had a single recurrence that was retreated with subsequent repeat clip ligation. Six patients had 7 blister aneurysms that were treated with endovascularly. One (16.7%) of these patients had a single recurrence that was retreated with subsequent coil embolization. Postoperative vasospasm occurred in 8 (44.4%) patients, one of whom suffered from a stroke. This is one of the largest single-institution dICA blister aneurysm studies to date. There was no detected significant difference between microsurgical clip ligation and endovascular coil embolization in terms of surgical outcome. These blister aneurysms demonstrate a propensity to be associated with multiple cerebral aneurysms. Strict clinical and angiographic long-term follow-up may be warranted.
Statement of Significance: Blister aneurysms are focal wall defects covered by a thin layer of fibrous tissue and adventitia, lacking the usual collagenous layer. Due to their pathologically thin vessel wall, blister aneurysms are prone to rupture. The management of these rare and fragile aneurysms presents a number of challenges. Here, we address the long-term outcome of patients treated for blister aneurysms at non-branching sites of the dICA. The presented data and analysis is imperative to determine the necessary strict long-term clinical and angiographic follow-up.
(Copyright © 2017 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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