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Case series
Endovascular management of intracranial blister aneurysms: spectrum and limitations of contemporary techniques
  1. Ramsey Ashour1,2,
  2. Stephen Dodson1,
  3. M Ali Aziz-Sultan2
  1. 1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2Department of Neurosurgery, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Ramsey Ashour, Department of Neurosurgery, Harvard Medical School/Brigham and Women's Hospital, 75 Francis Street, PBB-311, Boston, MA 02115, USA; rashour{at}partners.org

Abstract

Background Intracranial blister aneurysms are rare lesions that are notoriously more difficult to treat than typical saccular aneurysms. High complication rates associated with surgery have sparked considerable interest in endovascular techniques, though not well-studied, to treat blister aneurysms.

Objective To evaluate our experience using various endovascular approaches to treat blister aneurysms.

Methods All consecutive blister aneurysms treated using an endovascular approach by the study authors over a 3-year period were retrospectively analyzed. A literature review was also performed.

Results Nine patients with blister aneurysms underwent 11 endovascular interventions. In various combinations, stents were used in 8/11, coils in 5/11, and Onyx in 3/11 procedures. At mean angiographic follow-up of 200 days, 8/9 aneurysms were completely occluded by endovascular means alone requiring no further treatment and 1/9 aneurysms required surgical bypass/trapping after one failed surgical and two failed endovascular treatments. At mean clinical follow-up of 416 days, modified Rankin Scale scores were improved in six patients, stable in two, and worsened in one patient. One complication occurred in 11 procedures (9%), resulting in a permanent neurologic deficit. No unintended endovascular parent vessel sacrifice, intraprocedural aneurysmal ruptures, antiplatelet-related complications, post-treatment aneurysmal re-ruptures, or deaths occurred.

Conclusion This series highlights both the spectrum and limitations of endovascular techniques currently used to treat blister aneurysms, including a novel application of stent-assisted Onyx embolization. Long-term follow-up and experience in larger studies are required to better define the role of endovascular therapy in the management of these difficult lesions.

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