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Reconstructive Treatment of Ruptured Blood Blister-like Aneurysms With Stent and Coil

 Yong Cheol Lim  ;  Byung Moon Kim  ;  Sang Hyun Suh  ;  Pyoung Jeon  ;  Sang Heum Kim  ;  Yon-Kwon Ihn  ;  Young-Jun Lee  ;  Sook Young Sim  ;  Joonho Chung  ;  Dong Joon Kim  ;  Dong Ik Kim 
 NEUROSURGERY, Vol.73(3) : 480-488, 2013 
Journal Title
Issue Date
Adult ; Aneurysm, Ruptured ; Blister/pathology* ; Cerebral Angiography/methods ; Embolization, Therapeutic/instrumentation* ; Embolization, Therapeutic/methods* ; Female ; Humans ; Intracranial Aneurysm/complications ; Intracranial Aneurysm/surgery* ; Male ; Middle Aged ; Retrospective Studies ; Stents* ; Treatment Outcome
Blood blister-like aneurysm ; Outcomes ; Stent-assisted coiling
BACKGROUND: Controversy remains about the optimal treatment for blood blister--like aneurysms (BBAs). OBJECTIVE: To evaluate clinical and angiographic outcomes after reconstructive treatment for BBA with stent and coil. METHODS: Thirty-four patients (6 men, 28 women; mean age, 47.3 years) with ruptured BBAs underwent reconstructive treatment with stent and coil. Posttreatment courses and outcomes were retrospectively evaluated. RESULTS: Initial treatments were ≥ 2 overlapping stents with or without coiling (n = 28) and single stent with coiling (n = 6). Three BBAs rebled on days 9, 11, and 15 after treatment, resulting in 1 death. Except for 3 patients who died early, 31 patients were followed up for 7 to 80 months (median, 32 months). One patient recovered completely but died of complications of systemic lupus erythematosus at 25 months. Of the remaining 30 patients, 25 had favorable outcomes (modified Rankin scale, 0-2) and 5 had unfavorable outcomes. Angiographic follow-up was available in the 32 BBAs. Eight (25.0%) recurred, all within 5 weeks. In the multiple stents group (n = 26), 22 BBAs showed improvement or complete healing, but 4 (15.4%, 2 rebleedings) had recurrence. In the single stent with coiling group (n = 6), 2 BBAs were stable but 4 (66.7%, 1 rebleeding) had recurrence. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence (P < .05). CONCLUSION: Reconstructive treatment with stent and coil appears a viable option for BBAs. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence. Follow-up angiography should be considered mandatory soon after treatment. ABBREVIATIONS: BBA, blood blister--like aneurysmICA, internal carotid arterymRS, modified Rankin ScaleSAH, subarachnoid hemorrhage.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Chung, Joon Ho(정준호)
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