Long-term Follow-up of Blister Aneurysms of the Internal Carotid Artery
| Autor: | George A C Mendes, Felipe C. Albuquerque, M. Yashar S. Kalani, Peter Nakaji, Louis J. Kim, Cameron G. McDougall, Shakeel A. Chowdhry, Joseph M. Zabramski, Robert F. Spetzler |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Carotid Artery Diseases Male medicine.medical_specialty Subarachnoid hemorrhage Adolescent medicine.medical_treatment Glasgow Outcome Scale Time Young Adult Aneurysm Recurrence medicine.artery medicine Humans cardiovascular diseases Aged Retrospective Studies medicine.diagnostic_test business.industry Intracranial Aneurysm Retrospective cohort study Clipping (medicine) Middle Aged Surgical Instruments medicine.disease Surgery Stenosis Treatment Outcome Angiography cardiovascular system Female Neurology (clinical) Internal carotid artery business Vascular Surgical Procedures Carotid Artery Internal Follow-Up Studies |
| Zdroj: | Neurosurgery. 73:1026-1033 |
| ISSN: | 1524-4040 0148-396X |
| Popis: | BACKGROUND: Blister aneurysms of the internal carotid artery (ICA) are uncommon. There is a paucity of data on the long-term outcomes of patients. OBJECTIVE: To review our experience with the treatment of these lesions. METHODS: We retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed. RESULTS: Seventeen patients (3 male, 14 female) with 18 blister aneurysms of the ICA were identified. The mean age was 44.6 years (range, 17–72; median, 42 years). Twelve patients (70.6%) presented with aneurysmal subarachnoid hemorrhage. The mean admission Glasgow Outcome Scale score was 4.3 (range, 2–5; median, 5). All patients were initially treated using microsurgical technique with direct clipping (n = 15; 83.3%) or clip-wrapping with Gore-Tex (n = 3, 16.7%). There were 4 cases of intraoperative rupture, all associated with attempted direct clipping; all 4 cases were successfully clipped. Two cases rebled post-treatment. Both rebleeding episodes were managed with endovascular stenting. Follow-up angiography was available for 14 patients and revealed a new aneurysm adjacent to the site of clipping in 1 patient and in-stent stenosis in 2. At the mean follow-up of 74.5 months (median, 73; range, 7–165), the mean Glasgow Outcome Scale score was 4.6 (range, 2–5; median, 5). CONCLUSION: Microsurgical treatment of blister aneurysms of the ICA results in excellent outcome. In the evolution of treating these friable aneurysms, we have modified our clip-wrapping technique and use this technique when direct clipping is not feasible. |
| Databáze: | OpenAIRE |
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