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Forward deployed coil embolization with multiple overlapping stents for ruptured blood blister-like aneurysms: technical considerations and outcomes

 Myeong Jin Kim  ;  Joonho Chung  ;  Yong Sam Shin  ;  Yong Cheol Lim 
 NEUROLOGICAL RESEARCH, Vol.41(6) : 562-568, 2019 
Journal Title
Issue Date
Adult ; Aged ; Aneurysm, Ruptured/complications ; Aneurysm, Ruptured/surgery ; Blood Vessel Prosthesis ; Carotid Artery Diseases/complications ; Carotid Artery, Internal/surgery ; Embolization, Therapeutic/methods ; Endovascular Procedures ; Female ; Humans ; Intracranial Aneurysm/surgery ; Male ; Middle Aged ; Stents/adverse effects ; Subarachnoid Hemorrhage/complications ; Treatment Outcome
Blood blister–like aneurysm ;  multiple overlapping stents ; stent-assisted coiling ; subarachnoid hemorrhage
BACKGROUND: Coil embolization with multiple overlapping stents was performed as an alternative treatment option for blood blister-like aneurysms (BBAs). However, coil placement into the BBAs has the inherent risks of rupture and regrowth. We describe a safe dense coil packing technique into and just proximal of BBAs using a semi-jailing technique for the treatment of BBAs of the internal carotid artery (ICA) and report the long-term clinical outcomes. METHODS: The technique involves the partial deployment of a self-expanding and retrievable stent from the ICA bifurcation to the mid-portion of a BBA followed by coil embolization with gradual unsheathing of the stent from the BBA to its just proximal portion. Seventeen patients were treated using this technique (10 women; mean age, 47.9 ± 11 years; overall mean clinical follow-up period, 42.3 ± 22.8 months). Technique safety and feasibility, and follow-up angiographic results and clinical outcomes (modified Rankin Scale, mRS) were evaluated. RESULTS: Procedures were successfully applied without any procedure-related complications. Immediate post-treatment angiograms showed total obliteration of the BBAs in all 17 patients. Follow-up angiograms, which were available in 15 (88.2%) patients, showed complete resolution of BBAs. Fourteen (82.4%) of 17 patients achieved favorable clinical outcomes (mRS ≤ 2). CONCLUSIONS: Forward deployed coil embolization with multiple overlapping stents offers a safe and effective reconstructive endovascular technique for the treatment of the BBAs.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Chung, Joon Ho(정준호)
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