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Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister-Like Aneurysms.

Meckel, S; Singh, T P; Undrén, P; Ramgren, Birgitta LU ; Nilsson, O G; Phatouros, C; McAuliffe, W and Cronqvist, Mats LU (2011) In AJNR. American journal of neuroradiology 32. p.764-771
Abstract
BACKGROUND AND PURPOSE: BBA is a rare type of intracranial aneurysm that is difficult to treat both surgically and endovascularly and is often associated with a high degree of morbidity/mortality. The aim of this study was to present clinical and angiographic results, as well as antiplatelet/anticoagulation regimens, of endovascular BBA treatment by using predominantly stent-assisted coil embolization. MATERIALS AND METHODS: Thirteen patients (men/women, 6/7; mean age, 49.3 years) with ruptured BBAs were included from 2 different institutions. Angiographic findings, treatment strategies, anticoagulation/antiplatelet protocols, and clinical (mRS) and angiographic outcome were retrospectively analyzed. RESULTS: Eleven BBAs were located in... (More)
BACKGROUND AND PURPOSE: BBA is a rare type of intracranial aneurysm that is difficult to treat both surgically and endovascularly and is often associated with a high degree of morbidity/mortality. The aim of this study was to present clinical and angiographic results, as well as antiplatelet/anticoagulation regimens, of endovascular BBA treatment by using predominantly stent-assisted coil embolization. MATERIALS AND METHODS: Thirteen patients (men/women, 6/7; mean age, 49.3 years) with ruptured BBAs were included from 2 different institutions. Angiographic findings, treatment strategies, anticoagulation/antiplatelet protocols, and clinical (mRS) and angiographic outcome were retrospectively analyzed. RESULTS: Eleven BBAs were located in the supraclinoid ICA, and 2 on the basilar artery trunk. Nine of 13 were ≤3 mm in the largest diameter, and 8/13 showed early growth before treatment. Primary stent-assisted coiling was performed in 11/13 patients, double stents and PAO in 1 patient, each. Early complementary treatment was required in 3 patients, including PAO in 2. In stent-placement procedures, altered periprocedural antiplatelet (11/12) and postprocedural heparin (6/12) protocols were used without evidence of thromboembolic events. Two patients had early rehemorrhage, including 1 major fatal SAH. Twelve of 13 BBAs showed complete or progressive occlusion at late angiographic follow-up. Clinical midterm outcome was good (mRS scores, 0-2) in 12/13 patients. CONCLUSIONS: Stent-assisted coiling of ruptured BBAs is technically challenging but can be done with good midterm results. Reduced periprocedural and postprocedural antiplatelet/anticoagulation protocols may be used with a low reasonable risk of thromboembolic complications. However, regrowth/rerupture remains a problem underlining the importance of early angiographic follow-up and re-treatment, including PAO if necessary. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
AJNR. American journal of neuroradiology
volume
32
pages
764 - 771
publisher
American Society of Neuroradiology
external identifiers
  • wos:000289881300030
  • pmid:21372169
  • scopus:79954497130
ISSN
1936-959X
DOI
10.3174/ajnr.A2392
language
English
LU publication?
yes
id
1d222aa0-67b0-437f-b2c8-4ad9f53ed09f (old id 1884374)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21372169?dopt=Abstract
date added to LUP
2011-04-01 13:24:29
date last changed
2017-07-02 04:40:50
@article{1d222aa0-67b0-437f-b2c8-4ad9f53ed09f,
  abstract     = {BACKGROUND AND PURPOSE: BBA is a rare type of intracranial aneurysm that is difficult to treat both surgically and endovascularly and is often associated with a high degree of morbidity/mortality. The aim of this study was to present clinical and angiographic results, as well as antiplatelet/anticoagulation regimens, of endovascular BBA treatment by using predominantly stent-assisted coil embolization. MATERIALS AND METHODS: Thirteen patients (men/women, 6/7; mean age, 49.3 years) with ruptured BBAs were included from 2 different institutions. Angiographic findings, treatment strategies, anticoagulation/antiplatelet protocols, and clinical (mRS) and angiographic outcome were retrospectively analyzed. RESULTS: Eleven BBAs were located in the supraclinoid ICA, and 2 on the basilar artery trunk. Nine of 13 were ≤3 mm in the largest diameter, and 8/13 showed early growth before treatment. Primary stent-assisted coiling was performed in 11/13 patients, double stents and PAO in 1 patient, each. Early complementary treatment was required in 3 patients, including PAO in 2. In stent-placement procedures, altered periprocedural antiplatelet (11/12) and postprocedural heparin (6/12) protocols were used without evidence of thromboembolic events. Two patients had early rehemorrhage, including 1 major fatal SAH. Twelve of 13 BBAs showed complete or progressive occlusion at late angiographic follow-up. Clinical midterm outcome was good (mRS scores, 0-2) in 12/13 patients. CONCLUSIONS: Stent-assisted coiling of ruptured BBAs is technically challenging but can be done with good midterm results. Reduced periprocedural and postprocedural antiplatelet/anticoagulation protocols may be used with a low reasonable risk of thromboembolic complications. However, regrowth/rerupture remains a problem underlining the importance of early angiographic follow-up and re-treatment, including PAO if necessary.},
  author       = {Meckel, S and Singh, T P and Undrén, P and Ramgren, Birgitta and Nilsson, O G and Phatouros, C and McAuliffe, W and Cronqvist, Mats},
  issn         = {1936-959X},
  language     = {eng},
  pages        = {764--771},
  publisher    = {American Society of Neuroradiology},
  series       = {AJNR. American journal of neuroradiology},
  title        = {Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister-Like Aneurysms.},
  url          = {http://dx.doi.org/10.3174/ajnr.A2392},
  volume       = {32},
  year         = {2011},
}