title: Primary treatment of ruptured blood blister-like aneurysms with stent-assisted coil embolization: report of two cases.
abstract: Blood blister-like aneurysms (BBAs) are among the most hazardous cerebrovascular aneurysms to treat; microsurgical treatment of these small, wide-necked, and exceptionally fragile aneurysms place patients at significant risk of morbidity or mortality. We report two cases of ruptured BBAs attempted to be treated for the first time with stent-assisted coil embolization solely and review the current literature on treatment options. Our patients underwent stent-assisted coil embolization of the aneurysms in the acute stage of subarachnoid hemorrhage (SAH). One patient was successfully treated without procedure-related complications. The other patient died after surgical internal carotid artery (ICA) occlusion, carried out after intraoperative rerupture of the aneurysm during the endovascular treatment. In the successful case, 8-month and 19-month follow-up angiograms demonstrated incomplete (>90%) occlusion with residual filling of the aneurysm neck, which did not need additional coil embolization. Even though stent-assisted coil embolization of ruptured BBAs in the acute stage appears to be a technically feasible treatment option, the present stent-related endovascular technology has potentially hazardous drawbacks.
authors.affiliation: Department of Neurosurgery, Department of Neurology, and Department of Radiology, Turku University Hospital, Turku, Finland. miikka.korja@hus.fi
authors.forename: M
authors.initials: M
authors.lastname: Korja
authors.forename: R
authors.initials: R
authors.lastname: Rautio
authors.forename: S
authors.initials: S
authors.lastname: Valtonen
authors.forename: A
authors.initials: A
authors.lastname: Haapanen
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000209:etiology; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000379:methods*; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous; D015607:Stents; D020521:Stroke / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome