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Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister-Like Aneurysms

Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and... This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A2392v1 32/4/764 most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Meckel, S. Articles by Cronqvist, M. PubMed PubMed Citation Articles by Meckel, S. Articles by Cronqvist, M. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 32:764-771, April 2011 © 2011 American Society of Neuroradiology INTERVENTIONAL Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister–Like Aneurysms S. Meckel a ,b , T.P. Singh a , P. Undrén c , B. Ramgren c , O.G. Nilsson d , C. Phatouros a , W. McAuliffe a and M. Cronqvist c a Neurological Intervention and Imaging Service of Western Australia (S.M., T.P.S., C.P., W.M.), Sir Charles Gairdner and Royal Perth Hospitals, Nedlands, W.A., Australia b Department of Neuroradiology (S.M.), University Hospital Freiburg, Freiburg, Germany c Department of Neuroradiology (P.U., B.R., M.C.), Center for Medical Imaging and Physiology d Department of Neurosurgery (O.G.N.), Lund University Hospital, Lund, Sweden. Please address correspondence to Stephan Meckel, MD, Department of Neuroradiology, University Hospital Freiburg, Breisacher Str 64, D-79106 Freiburg, Germany; e-mail: stephanmeckel@gmail.com BACKGROUND AND PURPOSE: BBA is a rare type of intracranial aneurysm that is difficult to treat both surgically and endovascularly and is often associated with a high degree of morbidity/mortality. The aim of this study was to present clinical and angiographic results, as well as antiplatelet/anticoagulation regimens, of endovascular BBA treatment by using predominantly stent-assisted coil embolization. MATERIALS AND METHODS: Thirteen patients (men/women, 6/7; mean age, 49.3 years) with ruptured BBAs were included from 2 different institutions. Angiographic findings, treatment strategies, anticoagulation/antiplatelet protocols, and clinical (mRS) and angiographic outcome were retrospectively analyzed. RESULTS: Eleven BBAs were located in the supraclinoid ICA, and 2 on the basilar artery trunk. Nine of 13 were 3 mm in the largest diameter, and 8/13 showed early growth before treatment. Primary stent-assisted coiling was performed in 11/13 patients, double stents and PAO in 1 patient, each. Early complementary treatment was required in 3 patients, including PAO in 2. In stent-placement procedures, altered periprocedural antiplatelet (11/12) and postprocedural heparin (6/12) protocols were used without evidence of thromboembolic events. Two patients had early rehemorrhage, including 1 major fatal SAH. Twelve of 13 BBAs showed complete or progressive occlusion at late angiographic follow-up. Clinical midterm outcome was good (mRS scores, 0–2) in 12/13 patients. CONCLUSIONS: Stent-assisted coiling of ruptured BBAs is technically challenging but can be done with good midterm results. Reduced periprocedural and postprocedural antiplatelet/anticoagulation protocols may be used with a low reasonable risk of thromboembolic complications. However, regrowth/rerupture remains a problem underlining the importance of early angiographic follow-up and re-treatment, including PAO if necessary. Abbreviations: ACT, activated clotting time • antlat, anterolateral • antmed, anteromedial • BAP, balloon angioplasty • BA-T, basilar artery trunk • BBA, blood blister–like aneurysm • C6–7, ICA segments • coil protr, coil protrusion into parent artery • CTA, CT angiography • DSA, digital subtraction angiography • EVT, endovascular treatment • GDC, Guglielmi detachable coil • HH, Hunt and Hess scale • ICA, internal carotid artery • ICAP, intra-arterial chemical angioplasty • IV, intravenous • L, left • LMWH, low-molecular-weight heparin • med, medial • MM, medical management • MRA, MR angiography • mRS, modified Rankin Scale • NGT, nasogastric tube • low-dose s.c., 5000 IU heparin/day subcutaneously • PAO, parent artery occlusion • post, posterior • postmed, posteromedial • protr, protrusion • prox, proximal • R, right • SAH, subarachnoid hemorrhage • t-fibrin, transient fibrin formation Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2011 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister-Like Aneurysms

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2011 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A2392
Publisher site
See Article on Publisher Site

Abstract

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A2392v1 32/4/764 most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Meckel, S. Articles by Cronqvist, M. PubMed PubMed Citation Articles by Meckel, S. Articles by Cronqvist, M. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 32:764-771, April 2011 © 2011 American Society of Neuroradiology INTERVENTIONAL Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister–Like Aneurysms S. Meckel a ,b , T.P. Singh a , P. Undrén c , B. Ramgren c , O.G. Nilsson d , C. Phatouros a , W. McAuliffe a and M. Cronqvist c a Neurological Intervention and Imaging Service of Western Australia (S.M., T.P.S., C.P., W.M.), Sir Charles Gairdner and Royal Perth Hospitals, Nedlands, W.A., Australia b Department of Neuroradiology (S.M.), University Hospital Freiburg, Freiburg, Germany c Department of Neuroradiology (P.U., B.R., M.C.), Center for Medical Imaging and Physiology d Department of Neurosurgery (O.G.N.), Lund University Hospital, Lund, Sweden. Please address correspondence to Stephan Meckel, MD, Department of Neuroradiology, University Hospital Freiburg, Breisacher Str 64, D-79106 Freiburg, Germany; e-mail: stephanmeckel@gmail.com BACKGROUND AND PURPOSE: BBA is a rare type of intracranial aneurysm that is difficult to treat both surgically and endovascularly and is often associated with a high degree of morbidity/mortality. The aim of this study was to present clinical and angiographic results, as well as antiplatelet/anticoagulation regimens, of endovascular BBA treatment by using predominantly stent-assisted coil embolization. MATERIALS AND METHODS: Thirteen patients (men/women, 6/7; mean age, 49.3 years) with ruptured BBAs were included from 2 different institutions. Angiographic findings, treatment strategies, anticoagulation/antiplatelet protocols, and clinical (mRS) and angiographic outcome were retrospectively analyzed. RESULTS: Eleven BBAs were located in the supraclinoid ICA, and 2 on the basilar artery trunk. Nine of 13 were 3 mm in the largest diameter, and 8/13 showed early growth before treatment. Primary stent-assisted coiling was performed in 11/13 patients, double stents and PAO in 1 patient, each. Early complementary treatment was required in 3 patients, including PAO in 2. In stent-placement procedures, altered periprocedural antiplatelet (11/12) and postprocedural heparin (6/12) protocols were used without evidence of thromboembolic events. Two patients had early rehemorrhage, including 1 major fatal SAH. Twelve of 13 BBAs showed complete or progressive occlusion at late angiographic follow-up. Clinical midterm outcome was good (mRS scores, 0–2) in 12/13 patients. CONCLUSIONS: Stent-assisted coiling of ruptured BBAs is technically challenging but can be done with good midterm results. Reduced periprocedural and postprocedural antiplatelet/anticoagulation protocols may be used with a low reasonable risk of thromboembolic complications. However, regrowth/rerupture remains a problem underlining the importance of early angiographic follow-up and re-treatment, including PAO if necessary. Abbreviations: ACT, activated clotting time • antlat, anterolateral • antmed, anteromedial • BAP, balloon angioplasty • BA-T, basilar artery trunk • BBA, blood blister–like aneurysm • C6–7, ICA segments • coil protr, coil protrusion into parent artery • CTA, CT angiography • DSA, digital subtraction angiography • EVT, endovascular treatment • GDC, Guglielmi detachable coil • HH, Hunt and Hess scale • ICA, internal carotid artery • ICAP, intra-arterial chemical angioplasty • IV, intravenous • L, left • LMWH, low-molecular-weight heparin • med, medial • MM, medical management • MRA, MR angiography • mRS, modified Rankin Scale • NGT, nasogastric tube • low-dose s.c., 5000 IU heparin/day subcutaneously • PAO, parent artery occlusion • post, posterior • postmed, posteromedial • protr, protrusion • prox, proximal • R, right • SAH, subarachnoid hemorrhage • t-fibrin, transient fibrin formation Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2011 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Apr 1, 2011

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