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Original research
Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents
  1. Kubilay Aydin1,
  2. Anil Arat2,
  3. Serra Sencer1,
  4. Bahattin Hakyemez3,
  5. Mehmet Barburoglu1,
  6. Altay Sencer4,
  7. Nail İzgi4
  1. 1Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  2. 2Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
  3. 3Department of Radiology, Faculty of Medicine, Uludag University, Bursa, Turkey
  4. 4Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  1. Correspondence to Professor K Aydin, Department of Radiology, Istanbul Faculty of Medicine, Cerrahi Monoblok, Capa, Istanbul 34340, Turkey; dr.aydink{at}superonline.com, aydink{at}istanbul.edu.tr

Abstract

Introduction Blood blister-like aneurysms (BBAs) are fragile and difficult to treat. Routine surgical and endovascular treatment methods, such as clipping, clip wrapping, primary coiling, or stent assisted coiling, have relatively high morbidity and mortality rates. In this study, we report clinical and angiographic results for treatment of ruptured BBAs using flow diverter stents.

Methods We retrospectively reviewed patients who presented with subarachnoid hemorrhages caused by rupture of BBAs and who were treated using flow diverter stents at three neurointervention centers between January 2009 and January 2013. Clinical and angiographic findings, together with the procedural data and follow-up results, are reported.

Results 11 patients were identified in this study. BBAs were located on the supraclinoid internal carotid artery (nine patients) and basilar arteries (two patients). Eight patients were treated by implantation of a single flow diverter stent. Two flow diverter stents were telescopically deployed in each of three patients. The procedures were successful in all cases. No acute complications developed in any case. One patient who had an initial Hess–Hunt grade 4 died of septicemia 2 weeks after the procedure (9%). Another patient developed a minor stroke caused by parent artery thrombosis (9%). Control angiographies performed 3 and 6 months post stenting revealed complete occlusion of the aneurysms in all of the remaining nine patients (82%). 10 of the 11 patients (92%) had good clinical outcomes (modified Rankin Scale score ≤2).

Conclusions Implantation of flow diverter stents seems to be a safe and feasible alternative for treatment of ruptured BBAs.

  • Subarachnoid
  • Hemorrhage
  • Aneurysm
  • Flow Diverter

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