Endovascular coil embolization for saccular-shaped blood blister-like aneurysms of the internal carotid artery.
BACKGROUND
Because of their fragile and thin wall, ruptured blood blister-like aneurysms (BBAs) at the anterior wall of the internal carotid artery (ICA) are difficult to manage, both surgically, as well as endovascularly. BBA is usually a tiny and broad-necked aneurysm, but it occasionally demonstrates a relatively saccular-like shape. In addition, the pseudoaneurysm sac often assumes a saccular shape. In this paper, the authors present their experience in treating these saccular-shaped BBAs endovascularly with coil packing.


METHODS
Nine saccular-shaped ruptured BBAs in nine patients (one male and eight females; mean age 51.3 years, range 38-76) were treated with coil packing of the lesion between January 2006 and August 2010 in Nagoya University and its affiliated hospitals. Clinical, procedural, and angiographic data were retrospectively evaluated.


RESULTS
Seven BBAs were treated by balloon-assisted coil embolization. Two remaining BBAs were embolized without balloon inflation, though a balloon catheter was on standby at the ICA. In one case, in which a saccular coil embolization could not be achieved, ICA trapping was performed. Three (33.3%) were treated in acute, two (22.2%) in subacute, and four (44.4%) in chronic period. One (11.1%) intraoperative rupture occurred. Six (66.7%) had excellent clinical outcomes, while two (22.2%) proved fatal outcomes. During the follow-up period (mean 18.9 months, range 4-48), two out of seven (28.6%) aneurysms presented an angiographical recurrence, but both were treated by coil embolization without complications. The remaining five (71.4%) aneurysms were completely resolved.


CONCLUSIONS
Endovascular coil embolization can be considered as an alternative treatment option for selective saccular-shaped BBAs.
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan.
Noriaki
N
Matsubara
Shigeru
S
Miyachi
Nobuhiro
N
Tsukamoto
Takashi
T
Izumi
Takehiro
T
Naito
Kenichi
K
Haraguchi
Toshihiko
T
Wakabayashi
D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis / Q000592:standards*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology*; D020215:Carotid Artery, Internal, Dissection / Q000473:pathology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies