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Clip-wrapping of ruptured blood blister-like aneurysms of the internal carotid artery

Contributors

Meling, Torstein; Patet, Gildas

Published in

Neurosurgical Review

Publication date

2019

Abstract

To evaluate the safety and validity of microsurgical Gore-Tex clip-wrapping for ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA). Single-surgeon series. Retrospective study. Data analyzed were patient age, sex, Hunt and Hess grade (H&H), Fisher grade, time from rupture to hospitalization, aneurysm size and location, collateral capacity of the circle of Willis, time from hospitalization to aneurysm repair, aneurysm obliteration, complications, and modified Rankin scale (mRS) at follow-up. Six patients (2 males, 4 females) with ICA BBAs underwent clip-wrapping between 2011 and 2016. Median age was 50.0 years (range 31.7-54.0). H&H was grade 1 or 2 in 5 patients and grade 4 in 1 patient. All aneurysms were small (≤ 0.3 cm), without relation to vessel bifurcations, and located anteromedially, anterolaterally, and superomedially on the ICA trunk. Right side was most frequent (66%). All aneurysms could be clip-wrapped without intraoperative ruptures and all parent arteries could be preserved in the acute phase. Clip-wrapping completely eliminated the BBAs in five patients, whereas one patient underwent additional stent-assisted coiling. There were no re-ruptures, delayed infarctions, or deaths postoperatively. After a median follow-up of 57 months (range 20-90), outcome was favorable (mRS score 0-2) in all patients without radiographic signs of recurrences. Using the Gore-Tex clip-wrapping technique for ruptured ICA BBAs, the aneurysm could be treated without intraoperative ruptures or parent artery sacrifice in the acute phase. The outcomes were similar to other SAH patients and on follow-up, there were no aneurysm recurrences, indicating a durable long-term outcome.

Keywords

  • Aneurysm
  • Blood blister-like aneurysm
  • Internal carotid artery
  • Subarachnoid hemorrhage

UNIGE affiliation entities

Citation (ISO format)

MELING, Torstein, PATET, Gildas. Clip-wrapping of ruptured blood blister-like aneurysms of the internal carotid artery. In: Neurosurgical Review, 2019. doi: 10.1007/s10143-019-01172-7

Main files (1)

Article (Accepted version)

Identifiers

Journal ISSN

0344-5607
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470downloads

Technical informations

Creation

27/05/2020 15:24:00

First validation

27/05/2020 15:24:00

Update

15/03/2023 22:07:08

Status update

15/03/2023 22:07:08

Last indexation

31/10/2024 18:55:51
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