Long-Term Clinical and Angiographic Outcomes of Wrap-Clipping for Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery Using Advanced Monitoring
| Autor: | Kazuyuki Nishigaya, Koji Hashimoto, Hideyuki Yoshioka, Akira Fukamachi, Masahiro Shimizu, Kazuya Kanemaru, Mitsuto Hanihara, Hiroyuki Kinouchi |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Carotid Artery Internal Dissection Aneurysm Ruptured 03 medical and health sciences 0302 clinical medicine Aneurysm Modified Rankin Scale medicine.artery medicine Humans cardiovascular diseases Computed tomography angiography Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Intracranial Aneurysm Digital subtraction angiography Clipping (medicine) Middle Aged medicine.disease Surgical Instruments Stenosis Treatment Outcome 030220 oncology & carcinogenesis Angiography cardiovascular system Surgery Female Neurology (clinical) Radiology Internal carotid artery business Vascular Surgical Procedures 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. 126 |
| ISSN: | 1878-8769 |
| Popis: | Background Wrap-clipping is one of the recommended treatments for ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA). However, the long-term clinical and angiographic outcomes of this procedure have not yet been elucidated. The present study examined the long-term efficacy of wrap-clipping using a polytetrafluoroethylene membrane, an ideal wrapping material, for BBAs. Methods The data from 9 patients with ruptured BBAs treated at our institutes from 2007 to 2016 were retrospectively analyzed. Wrap-clipping was performed with advanced monitoring techniques, including fluorescence video angiography and endoscopy. Angiographic follow-up was achieved using 3-dimensional computed tomography angiography or digital subtraction angiography. Clinical outcomes were assessed using the modified Rankin scale. Results Wrap-clipping was performed without any permanent morbidity in all patients. Endoscopy visualized accurate margins of the aneurysmal pathological wall with high magnification and revealed the position of the clip blades and the surrounding perforators in the dead angles of the microscope. Fluorescence video angiography could confirm the blood flow of the ICA and the surrounding arteries. Regrowth of the aneurysm owing to the presence of a neck remnant occurred 1 month after treatment in 1 case that was repaired surgically. However, no other recurrence of BBAs or progression of ICA stenosis was observed by angiography with a mean follow-up period of 37 months. No repeat rupture or ischemic complications occurred, and all patients had a modified Rankin scale score of 0 with a mean follow-up period of 61 months. Conclusion Wrap-clipping using a polytetrafluoroethylene membrane for ruptured BBAs is a useful and acceptable procedure with long-term effectiveness. The effectiveness of this method can be ensured using modern monitoring methods. |
| Databáze: | OpenAIRE |
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