title: Multiple overlapping stents as monotherapy in the treatment of 'blister' pseudoaneurysms arising from the supraclinoid internal carotid artery: a single institution series and review of the literature.
abstract: BACKGROUND
  The 'blister-type' aneurysm is one of the most devastating cerebrovascular lesions. Flow diversion with stent reconstruction is an emerging treatment and has shown promising initial results.
  
  
  OBJECTIVE
  To evaluate the experience of one institution using stent reconstruction for pseudoaneurysms of the supraclinoid internal carotid artery and to compare with a review of the literature.
  
  
  METHODS
  A retrospective review from one institution identified eight patients with 'blister' aneurysms over a 47-month period. The Raymond scale was used to classify the aneurysms. Clinical data were obtained using the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale. A literature review was performed and compared with our results. Clinical and angiographic data were obtained.
  
  
  RESULTS
  After treatment, two aneurysms were Raymond class 1 (25%) and six were class 3 (75%). Of the class 3 aneurysms, two required retreatment, three (50%) progressed to complete occlusion and three (50%) had persistent aneurysm filling. Clinical data revealed two patients with mRS score of 0 (25%), five with mRS score of 1 (62.5%) and one with mRS score of 2 (12.5%). From the literature review, residual filling was evident in nine patients (64.3%) and complete occlusion in four (28.6%). On follow-up angiography, nine (64.3%) were occluded, two (14.3%) had residual neck filling and one (7.1%) had persistent aneurysm filling. Thirteen patients (92.9%) had an mRS score of 2 or better. Combining the available experience, patients demonstrated either improvement (n=9, 41%) or stability (n=11, 50%). Only two (9%) had progression requiring retreatment.
  
  
  CONCLUSIONS
  Endovascular stent remodeling of 'blister-type' aneurysms is a safe and effective strategy.
authors.affiliation: Department of Neurological Surgery, Division of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Walsh
authors.forename: Shaye I
authors.initials: SI
authors.lastname: Moskowitz
authors.forename: Ferdinand K
authors.initials: FK
authors.lastname: Hui
authors.forename: Alejandro M
authors.initials: AM
authors.lastname: Spiotta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy*; D001768:Blister / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
keywords: Stent