title: Reconstructive treatment of ruptured blood blister-like aneurysms with stent and coil.
abstract: 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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  BBA, blood blister--like aneurysmICA, internal carotid arterymRS, modified Rankin ScaleSAH, subarachnoid hemorrhage.
authors.affiliation: Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, South Korea.
authors.forename: Yong Cheol
authors.initials: YC
authors.lastname: Lim
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Suh
authors.forename: Pyoung
authors.initials: P
authors.lastname: Jeon
authors.forename: Sang Heum
authors.initials: SH
authors.lastname: Kim
authors.forename: Yon-Kwon
authors.initials: YK
authors.lastname: Ihn
authors.forename: Young-Jun
authors.initials: YJ
authors.lastname: Lee
authors.forename: Sook Young
authors.initials: SY
authors.lastname: Sim
authors.forename: Joonho
authors.initials: J
authors.lastname: Chung
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured; D001768:Blister / Q000473:pathology*; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome