Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister-Like Aneurysms.
(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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1884374
- author
- Meckel, S ; Singh, T P ; Undrén, P LU ; Ramgren, Birgitta LU ; Nilsson, O G LU ; Phatouros, C ; McAuliffe, W and Cronqvist, Mats LU
- organization
- publishing date
- 2011
- 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
- 2016-04-04 09:44:06
- date last changed
- 2022-02-28 17:22:03
@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}},
doi = {{10.3174/ajnr.A2392}},
volume = {{32}},
year = {{2011}},
}