title: Long-term follow-up analysis of microsurgical clip ligation and endovascular coil embolization for dorsal wall blister aneurysms of the internal carotid artery.
abstract: Blister aneurysms at non-branching sites of the dorsal internal carotid artery (dICA) are fragile, rare, and often difficult to treat. The purpose of this study is to address the demographics, treatment modalities, and long-term outcome of patients treated for dICA blister aneurysms. A retrospective review of medical records identified all consecutive patients who presented with a blister aneurysm from 2002 to 2011 at our institution. Eighteen patients (M=7, F=11; mean age: 48.4±15.1years; range: 15-65years) harbored a total of 43 aneurysms, 25 of which were dorsal wall blister aneurysms of the ICA. Eleven (61.1%) patients presented with aneurysmal subarachnoid hemorrhage (aSAH), and 10 (55.6%) patients had multiple aneurysms at admission. Twelve patients had 18 aneurysms that were treated microsurgically. Five (41.7%) of these patients had a single recurrence that was retreated with subsequent repeat clip ligation. Six patients had 7 blister aneurysms that were treated with endovascularly. One (16.7%) of these patients had a single recurrence that was retreated with subsequent coil embolization. Postoperative vasospasm occurred in 8 (44.4%) patients, one of whom suffered from a stroke. This is one of the largest single-institution dICA blister aneurysm studies to date. There was no detected significant difference between microsurgical clip ligation and endovascular coil embolization in terms of surgical outcome. These blister aneurysms demonstrate a propensity to be associated with multiple cerebral aneurysms. Strict clinical and angiographic long-term follow-up may be warranted.
  
  
  
  Blister aneurysms are focal wall defects covered by a thin layer of fibrous tissue and adventitia, lacking the usual collagenous layer. Due to their pathologically thin vessel wall, blister aneurysms are prone to rupture. The management of these rare and fragile aneurysms presents a number of challenges. Here, we address the long-term outcome of patients treated for blister aneurysms at non-branching sites of the dICA. The presented data and analysis is imperative to determine the necessary strict long-term clinical and angiographic follow-up.
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: Mason A
authors.initials: MA
authors.lastname: Brown
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: Cristian F
authors.initials: CF
authors.lastname: Guandique
authors.affiliation: Carolinas HealthCare System, Charlotte, NC, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Parish
authors.affiliation: Boston University School of Medicine, Boston, MA, United States.
authors.forename: Aubrey C
authors.initials: AC
authors.lastname: McMillan
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lehnert
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: Nassir
authors.initials: N
authors.lastname: Mansour
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Tu
authors.affiliation: Department of Neurosurgery, University Health Sciences Center, Oklahoma City, OK, United States.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Bohnstedt
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: Troy D
authors.initials: TD
authors.lastname: Payner
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Leipzig
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: DeNardo
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: John A
authors.initials: JA
authors.lastname: Scott
authors.affiliation: Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001768:Blister / Q000000981:diagnostic imaging / Q000601:surgery; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment / Q000379:methods; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Bilster aneurysm; Clip ligation; Dorsal wall aneurysm; Embolization; Endovascular coiling; Internal carotid artery; Stenting