Long-term follow-up of blister aneurysms of the internal carotid artery

M. Yashar S. Kalani, Joseph M. Zabramski, Louis J. Kim, Shakeel A. Chowdhry, George A.C. Mendes, Peter Nakaji, Cameron McDougall, Felipe C. Albuquerque, Robert F. Spetzler

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Blister aneurysms of the internal carotid artery (ICA) are uncommon. There is a paucity of data on the long-term outcomes of patients. OBJECTIVE: To review our experience with the treatment of these lesions. METHODS: We retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed. RESULTS: Seventeen patients (3 male, 14 female) with 18 blister aneurysms of the ICA were identified. The mean age was 44.6 years (range, 17-72; median, 42 years). Twelve patients (70.6%) presented with aneurysmal subarachnoid hemorrhage. The mean admission Glasgow Outcome Scale score was 4.3 (range, 2-5; median, 5). All patients were initially treated using microsurgical technique with direct clipping (n = 15; 83.3%) or clip-wrapping with Gore-Tex (n = 3, 16.7%). There were 4 cases of intraoperative rupture, all associated with attempted direct clipping; all 4 cases were successfully clipped. Two cases rebled post-treatment. Both rebleeding episodes were managed with endovascular stenting. Follow-up angiography was available for 14 patients and revealed a new aneurysm adjacent to the site of clipping in 1 patient and in-stent stenosis in 2. At the mean follow-up of 74.5 months (median, 73; range, 7-165), the mean Glasgow Outcome Scale score was 4.6 (range, 2-5; median, 5). CONCLUSION: Microsurgical treatment of blister aneurysms of the ICA results in excellent outcome. In the evolution of treating these friable aneurysms, we have modified our clip-wrapping technique and use this technique when direct clipping is not feasible.

Original languageEnglish (US)
Pages (from-to)1026-1033
Number of pages8
JournalNeurosurgery
Volume73
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

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Internal Carotid Artery
Blister
Aneurysm
Glasgow Outcome Scale
Surgical Instruments
Subarachnoid Hemorrhage
Radiology
Stents
Inpatients
Rupture
Angiography
Pathologic Constriction
Outpatients
Therapeutics

Keywords

  • Aneurysm
  • Blister
  • Endovascular
  • Internal carotid artery
  • Stenting
  • Wrapping

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Kalani, M. Y. S., Zabramski, J. M., Kim, L. J., Chowdhry, S. A., Mendes, G. A. C., Nakaji, P., ... Spetzler, R. F. (2013). Long-term follow-up of blister aneurysms of the internal carotid artery. Neurosurgery, 73(6), 1026-1033. https://doi.org/10.1227/NEU.0000000000000147

Long-term follow-up of blister aneurysms of the internal carotid artery. / Kalani, M. Yashar S.; Zabramski, Joseph M.; Kim, Louis J.; Chowdhry, Shakeel A.; Mendes, George A.C.; Nakaji, Peter; McDougall, Cameron; Albuquerque, Felipe C.; Spetzler, Robert F.

In: Neurosurgery, Vol. 73, No. 6, 01.12.2013, p. 1026-1033.

Research output: Contribution to journalArticle

Kalani, MYS, Zabramski, JM, Kim, LJ, Chowdhry, SA, Mendes, GAC, Nakaji, P, McDougall, C, Albuquerque, FC & Spetzler, RF 2013, 'Long-term follow-up of blister aneurysms of the internal carotid artery', Neurosurgery, vol. 73, no. 6, pp. 1026-1033. https://doi.org/10.1227/NEU.0000000000000147
Kalani MYS, Zabramski JM, Kim LJ, Chowdhry SA, Mendes GAC, Nakaji P et al. Long-term follow-up of blister aneurysms of the internal carotid artery. Neurosurgery. 2013 Dec 1;73(6):1026-1033. https://doi.org/10.1227/NEU.0000000000000147
Kalani, M. Yashar S. ; Zabramski, Joseph M. ; Kim, Louis J. ; Chowdhry, Shakeel A. ; Mendes, George A.C. ; Nakaji, Peter ; McDougall, Cameron ; Albuquerque, Felipe C. ; Spetzler, Robert F. / Long-term follow-up of blister aneurysms of the internal carotid artery. In: Neurosurgery. 2013 ; Vol. 73, No. 6. pp. 1026-1033.
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abstract = "BACKGROUND: Blister aneurysms of the internal carotid artery (ICA) are uncommon. There is a paucity of data on the long-term outcomes of patients. OBJECTIVE: To review our experience with the treatment of these lesions. METHODS: We retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed. RESULTS: Seventeen patients (3 male, 14 female) with 18 blister aneurysms of the ICA were identified. The mean age was 44.6 years (range, 17-72; median, 42 years). Twelve patients (70.6{\%}) presented with aneurysmal subarachnoid hemorrhage. The mean admission Glasgow Outcome Scale score was 4.3 (range, 2-5; median, 5). All patients were initially treated using microsurgical technique with direct clipping (n = 15; 83.3{\%}) or clip-wrapping with Gore-Tex (n = 3, 16.7{\%}). There were 4 cases of intraoperative rupture, all associated with attempted direct clipping; all 4 cases were successfully clipped. Two cases rebled post-treatment. Both rebleeding episodes were managed with endovascular stenting. Follow-up angiography was available for 14 patients and revealed a new aneurysm adjacent to the site of clipping in 1 patient and in-stent stenosis in 2. At the mean follow-up of 74.5 months (median, 73; range, 7-165), the mean Glasgow Outcome Scale score was 4.6 (range, 2-5; median, 5). CONCLUSION: Microsurgical treatment of blister aneurysms of the ICA results in excellent outcome. In the evolution of treating these friable aneurysms, we have modified our clip-wrapping technique and use this technique when direct clipping is not feasible.",
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AU - Kalani, M. Yashar S.

AU - Zabramski, Joseph M.

AU - Kim, Louis J.

AU - Chowdhry, Shakeel A.

AU - Mendes, George A.C.

AU - Nakaji, Peter

AU - McDougall, Cameron

AU - Albuquerque, Felipe C.

AU - Spetzler, Robert F.

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N2 - BACKGROUND: Blister aneurysms of the internal carotid artery (ICA) are uncommon. There is a paucity of data on the long-term outcomes of patients. OBJECTIVE: To review our experience with the treatment of these lesions. METHODS: We retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed. RESULTS: Seventeen patients (3 male, 14 female) with 18 blister aneurysms of the ICA were identified. The mean age was 44.6 years (range, 17-72; median, 42 years). Twelve patients (70.6%) presented with aneurysmal subarachnoid hemorrhage. The mean admission Glasgow Outcome Scale score was 4.3 (range, 2-5; median, 5). All patients were initially treated using microsurgical technique with direct clipping (n = 15; 83.3%) or clip-wrapping with Gore-Tex (n = 3, 16.7%). There were 4 cases of intraoperative rupture, all associated with attempted direct clipping; all 4 cases were successfully clipped. Two cases rebled post-treatment. Both rebleeding episodes were managed with endovascular stenting. Follow-up angiography was available for 14 patients and revealed a new aneurysm adjacent to the site of clipping in 1 patient and in-stent stenosis in 2. At the mean follow-up of 74.5 months (median, 73; range, 7-165), the mean Glasgow Outcome Scale score was 4.6 (range, 2-5; median, 5). CONCLUSION: Microsurgical treatment of blister aneurysms of the ICA results in excellent outcome. In the evolution of treating these friable aneurysms, we have modified our clip-wrapping technique and use this technique when direct clipping is not feasible.

AB - BACKGROUND: Blister aneurysms of the internal carotid artery (ICA) are uncommon. There is a paucity of data on the long-term outcomes of patients. OBJECTIVE: To review our experience with the treatment of these lesions. METHODS: We retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed. RESULTS: Seventeen patients (3 male, 14 female) with 18 blister aneurysms of the ICA were identified. The mean age was 44.6 years (range, 17-72; median, 42 years). Twelve patients (70.6%) presented with aneurysmal subarachnoid hemorrhage. The mean admission Glasgow Outcome Scale score was 4.3 (range, 2-5; median, 5). All patients were initially treated using microsurgical technique with direct clipping (n = 15; 83.3%) or clip-wrapping with Gore-Tex (n = 3, 16.7%). There were 4 cases of intraoperative rupture, all associated with attempted direct clipping; all 4 cases were successfully clipped. Two cases rebled post-treatment. Both rebleeding episodes were managed with endovascular stenting. Follow-up angiography was available for 14 patients and revealed a new aneurysm adjacent to the site of clipping in 1 patient and in-stent stenosis in 2. At the mean follow-up of 74.5 months (median, 73; range, 7-165), the mean Glasgow Outcome Scale score was 4.6 (range, 2-5; median, 5). CONCLUSION: Microsurgical treatment of blister aneurysms of the ICA results in excellent outcome. In the evolution of treating these friable aneurysms, we have modified our clip-wrapping technique and use this technique when direct clipping is not feasible.

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KW - Stenting

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