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Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms

Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal... This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1893v1 31/4/640 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map 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 HighWire Citing Articles via CrossRef Google Scholar Articles by Gaughen, J. R. Articles by Evans, A. J. PubMed PubMed Citation Articles by Gaughen, J. R., Jr Articles by Evans, A. J. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:640-644, April 2010 © 2010 American Society of Neuroradiology INTERVENTIONAL Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms J.R. Gaughen, Jr a , P. Raghavan a , M.E. Jensen a , D. Hasan c , A.N. Pfeffer b and A.J. Evans a a From the Department of Radiology (J.R.G., P.R., M.E.J., A.J.E.) b University of Virginia School of Medicine (A.N.P.), University of Virginia Health System, Charlottesville, Virginia c Department of Neurosurgery, (D.H.), University of Iowa Hospitals and Clinic, Iowa City, Iowa. Please address correspondence to John R. Gaughen, Jr, MD, Department of Radiology, Box 800170, Charlottesville, VA 22908; e-mail: jrg4@virginia.edu BACKGROUND AND PURPOSE: Blister aneurysms of the supraclinoid ICA represent a rare but potentially catastrophic cause of SAH, often presenting both diagnostic and therapeutic dilemmas. We explore the utility of CTA in the identification and characterization of ICA blister aneurysms. MATERIALS AND METHODS: We performed a retrospective review of catheter cerebral angiograms obtained at our institution over a 12-month period for evaluation of SAH, identifying 6 cases of ICA blister aneurysms. All patients underwent CTA and DSA for evaluation of SAH. The reports from the CTA and DSA studies were reviewed to identify aneurysms correctly diagnosed prospectively. Retrospective review of the CTA and DSA images was also performed. Review of the interpretations and images was performed for any follow-up studies. RESULTS: All 6 patients presented with SAH, diagnosed by head CT. All patients subsequently underwent CTA prior to DSA evaluation. All 6 aneurysms were identified prospectively on initial DSA imaging. Of the 6 blister aneurysms, 4 (67%) were identified prospectively; and 5 (83%), retrospectively on CTA. All 6 patients underwent endovascular treatment with stent placement. Four of the 6 aneurysms underwent follow-up CTA (range, 9–22 days), including the 2 aneurysms that had been unidentifiable preprocedurally. All 4 blister aneurysms were seen postprocedurally by DSA. Three of these 4 (75%) residual aneurysms were detected by CTA (both prospectively and retrospectively). CONCLUSIONS: In the presence of SAH and otherwise negative findings on CTA, a catheter cerebral angiogram should be performed to absolutely exclude an ICA blister aneurysm. Abbreviations: CTA, CT angiography • DSA, digital subtraction angiography • ICA, internal carotid artery • MIP, maximum intensity projections • MPR, multiplanar reconstruction • SAH, subarachnoid hemorrhage This article has been cited by other articles: J. R. Gaughen Jr, D. Hasan, A. S. Dumont, M. E. Jensen, J. Mckenzie, and A. J. Evans The Efficacy of Endovascular Stenting in the Treatment of Supraclinoid Internal Carotid Artery Blister Aneurysms Using a Stent-in-Stent Technique AJNR Am. J. Neuroradiol., June 1, 2010; 31(6): 1132 - 1138. Abstract Full Text PDF Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 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

Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms

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References (9)

Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A1893
Publisher site
See Article on Publisher Site

Abstract

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1893v1 31/4/640 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map 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 HighWire Citing Articles via CrossRef Google Scholar Articles by Gaughen, J. R. Articles by Evans, A. J. PubMed PubMed Citation Articles by Gaughen, J. R., Jr Articles by Evans, A. J. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 31:640-644, April 2010 © 2010 American Society of Neuroradiology INTERVENTIONAL Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms J.R. Gaughen, Jr a , P. Raghavan a , M.E. Jensen a , D. Hasan c , A.N. Pfeffer b and A.J. Evans a a From the Department of Radiology (J.R.G., P.R., M.E.J., A.J.E.) b University of Virginia School of Medicine (A.N.P.), University of Virginia Health System, Charlottesville, Virginia c Department of Neurosurgery, (D.H.), University of Iowa Hospitals and Clinic, Iowa City, Iowa. Please address correspondence to John R. Gaughen, Jr, MD, Department of Radiology, Box 800170, Charlottesville, VA 22908; e-mail: jrg4@virginia.edu BACKGROUND AND PURPOSE: Blister aneurysms of the supraclinoid ICA represent a rare but potentially catastrophic cause of SAH, often presenting both diagnostic and therapeutic dilemmas. We explore the utility of CTA in the identification and characterization of ICA blister aneurysms. MATERIALS AND METHODS: We performed a retrospective review of catheter cerebral angiograms obtained at our institution over a 12-month period for evaluation of SAH, identifying 6 cases of ICA blister aneurysms. All patients underwent CTA and DSA for evaluation of SAH. The reports from the CTA and DSA studies were reviewed to identify aneurysms correctly diagnosed prospectively. Retrospective review of the CTA and DSA images was also performed. Review of the interpretations and images was performed for any follow-up studies. RESULTS: All 6 patients presented with SAH, diagnosed by head CT. All patients subsequently underwent CTA prior to DSA evaluation. All 6 aneurysms were identified prospectively on initial DSA imaging. Of the 6 blister aneurysms, 4 (67%) were identified prospectively; and 5 (83%), retrospectively on CTA. All 6 patients underwent endovascular treatment with stent placement. Four of the 6 aneurysms underwent follow-up CTA (range, 9–22 days), including the 2 aneurysms that had been unidentifiable preprocedurally. All 4 blister aneurysms were seen postprocedurally by DSA. Three of these 4 (75%) residual aneurysms were detected by CTA (both prospectively and retrospectively). CONCLUSIONS: In the presence of SAH and otherwise negative findings on CTA, a catheter cerebral angiogram should be performed to absolutely exclude an ICA blister aneurysm. Abbreviations: CTA, CT angiography • DSA, digital subtraction angiography • ICA, internal carotid artery • MIP, maximum intensity projections • MPR, multiplanar reconstruction • SAH, subarachnoid hemorrhage This article has been cited by other articles: J. R. Gaughen Jr, D. Hasan, A. S. Dumont, M. E. Jensen, J. Mckenzie, and A. J. Evans The Efficacy of Endovascular Stenting in the Treatment of Supraclinoid Internal Carotid Artery Blister Aneurysms Using a Stent-in-Stent Technique AJNR Am. J. Neuroradiol., June 1, 2010; 31(6): 1132 - 1138. Abstract Full Text PDF Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 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, 2010

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