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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2021; 05(03): 158-166
DOI: 10.1055/s-0041-1726166
Review Article

Internal Carotid Artery Blister Aneurysm: Review of Endovascular Techniques

Vipul Gupta
1   Departement of Interventional Neuroradiology, Artemis Hospital, Gurgaon, Haryana, India
,
Shrikant Londhe
1   Departement of Interventional Neuroradiology, Artemis Hospital, Gurgaon, Haryana, India
,
Rajsrinivas Parthasarathy
1   Departement of Interventional Neuroradiology, Artemis Hospital, Gurgaon, Haryana, India
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Abstract

Cerebral blister aneurysms are very difficult vascular lesions in terms of accurate diagnosis as well as proper management strategy for vascular neurosurgeons and neurointerventionists. Histopathological analysis has revealed their nature to be more akin to pseudoaneurysms in comparison to the typical berry aneurysms. This explains their fragile nature, with high probability of rerupture and regrowth during the follow-up if not addressed properly. Even though surgical approaches have evolved over the years to minimize intraprocedural rupture and recurrence, they still have relatively high morbidity as well as mortality in comparison to endovascular treatment. Over the last few years, endovascular treatment has evolved significantly, with introduction of new devices and techniques. Focus of the endovascular management has shifted from the deconstructive techniques to reconstructive ones with parent artery preservation. Recent introduction of flow diverter technology has enabled neurointerventionists to manage these difficult lesions with more confidence in terms of avoiding rerupture and recurrence. Flow diverter (FD) use in blister aneurysm resulted in high-technical success, complete aneurysm occlusion, and less complications in comparison to other reconstructive techniques like simple coiling, stent assisted coiling, and overlapping/monotherapy stent placement. Few debatable issues like use of dual antiplatelets in the setting of acute subarachnoid hemorrhage (SAH), timing of drugs in relation to procedures, single/overlapping devices, and concerns during cerebral vasospasm phase need further detailed analysis and standardized protocols. In this article, we have done a review of different endovascular treatment options in the management of internal carotid artery blister aneurysms with special focus on FD and issues related to it.

Keywords

blister aneurysms - endovascular management - flow diverter


Publication History

Article published online:
14 April 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Abe M, Tabuchi K, Yokoyama H, Uchino A. Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 1998; 89 (03) 419-424
    CrossrefPubMedGoogle Scholar
  • 2 Regelsberger J, Matschke J, Grzyska U. et al Blister-like aneurysms–a diagnostic and therapeutic challenge. Neurosurg Rev 2011; 34 (04) 409-416
    CrossrefPubMedGoogle Scholar
  • 3 Cıkla U, Sadighi A, Bauer A, Başkaya MK. Fatal ruptured blood blister-like aneurysm of middle cerebral artery associated with Ehlers-Danlos syndrome type VIII (periodontitis type).. J Neurol Surg Rep 2014; 75 (02) e210-e213
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Andaluz N, Zuccarello M. Blister-like aneurysms of the anterior communicating artery: a retrospective review of diagnosis and treatment in five patients. Neurosurgery 2008; 62 (04) 807-811 discussion 811
    CrossrefPubMedGoogle Scholar
  • 5 Ishikawa T, Nakamura N, Houkin K, Nomura M. Pathological consideration of a “blister-like” aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery 1997; 40 (02) 403-405 discussion 405–406
    CrossrefPubMedGoogle Scholar
  • 6 Peitz GW, Sy CA, Grandhi R. Endovascular treatment of blister aneurysms. Neurosurg Focus 2017; 42 (06) E12
    CrossrefPubMedGoogle Scholar
  • 7 Ogawa A, Suzuki M, Ogasawara K. Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery 2000; 47 (03) 578-583 discussion 583–586
    PubMedGoogle Scholar
  • 8 Ashour R, Dodson S, Aziz-Sultan MA. Endovascular management of intracranial blister aneurysms: spectrum and limitations of contemporary techniques. J Neurointerv Surg 2016; 8 (01) 30-37
    CrossrefPubMedGoogle Scholar
  • 9 Peschillo S, Cannizzaro D, Caporlingua A, Missori P. A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms. AJNR Am J Neuroradiol 2016; 37 (05) 856-861
    CrossrefPubMedGoogle Scholar
  • 10 Gonzalez AM, Narata AP, Yilmaz H. et al Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol 2014; 83 (01) 197-205
    CrossrefPubMedGoogle Scholar
  • 11 Walsh KM, Moskowitz SI, Hui FK, Spiotta AM. Multiple overlapping stents as monotherapy in the treatment of ‘blister’ pseudoaneurysms arising from the supraclinoid internal carotid artery: a single institution series and review of the literature. J Neurointerv Surg 2014; 6 (03) 184-194
    CrossrefPubMedGoogle Scholar
  • 12 Ren Y, Liu L, Sun H. et al Microsurgical versus endovascular treatments for blood-blister aneurysms of the internal carotid artery: a retrospective study of 83 patients in a single center. World Neurosurg 2018; 109: e615-e624
    CrossrefPubMedGoogle Scholar
  • 13 Rouchaud A, Brinjikji W, Cloft HJ, Kallmes DF. Endovascular treatment of ruptured blister-like aneurysms: a systematic review and meta-analysis with focus on deconstructive versus reconstructive and flow-diverter treatments. AJNR Am J Neuroradiol 2015; 36 (12) 2331-2339
    CrossrefPubMedGoogle Scholar
  • 14 Sorteberg A. Balloon occlusion tests and therapeutic vessel occlusions revisited: when, when not, and how. AJNR Am J Neuroradiol 2014; 35 (05) 862-865
    CrossrefPubMedGoogle Scholar
  • 15 Park JH, Park IS, Han DH. et al Endovascular treatment of blood blister-like aneurysms of the internal carotid artery. J Neurosurg 2007; 106 (05) 812-819
    CrossrefPubMedGoogle Scholar
  • 16 Ahn JY, Cho JH, Jung JY, Lee BH, Yoon PH. Blister-like aneurysms of the supraclinoid internal carotid artery: challenging endovascular treatment with stent-assisted coiling. J Clin Neurosci 2008; 15 (09) 1058-1061
    CrossrefPubMedGoogle Scholar
  • 17 Meckel S, Singh TP, Undrén P. et al Endovascular treatment using predominantly stent-assisted coil embolization and antiplatelet and anticoagulation management of ruptured blood blister-like aneurysms. Am J Neuroradiol 2011; 32 (04) 764-771
    CrossrefPubMedGoogle Scholar
  • 18 Xu D, Zhang C, Wang T. et al Evaluation of enterprise stent-assisted coiling and telescoping stent technique as treatment of supraclinoid blister aneurysms of the internal carotid artery. World Neurosurg 2018; 110: e890-e896
    CrossrefPubMedGoogle Scholar
  • 19 Chinchure SD, Gupta V, Goel G, Gupta A, Jha A. Subarachnoid hemorrhage with blister aneurysms: Endovascular management. Neurol India 2014; 62 (04) 393-399
    CrossrefPubMedGoogle Scholar
  • 20 Xiang J, Damiano RJ, Lin N. et al High-fidelity virtual stenting: modeling of flow diverter deployment for hemodynamic characterization of complex intracranial aneurysms. J Neurosurg 2015; 123 (04) 832-840
    CrossrefPubMedGoogle Scholar
  • 21 Ryan RW, Khan AS, Barco R, Choulakian A. Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy. Neurosurg Focus 2017; 42 (06) E11
    CrossrefPubMedGoogle Scholar
  • 22 Yoon JW, Siddiqui AH, Dumont TM. et al Endovascular Neurosurgery Research Group. Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms. Neurosurgery 2014; 75 (04) 419-429 discussion 429
    CrossrefPubMedGoogle Scholar
  • 23 Mokin M, Chinea A, Primiani CT. et al Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. J Neurointerv Surg 2018; 10 (11) 1074-1078
    CrossrefPubMedGoogle Scholar
  • 24 Damiano RJ, Tutino VM, Paliwal N. et al Compacting a single flow diverter vs. overlapping flow diverters for intracranial aneurysm: a computational study. Am J Neuroradiol 2017; 38 (03) 603-610
    CrossrefPubMedGoogle Scholar
  • 25 Yang C, Vadasz A, Szikora I. Treatment of ruptured blood blister aneurysms using primary flow-diverter stenting with considerations for adjunctive coiling: a single-centre experience and literature review. Interv Neuroradiol 2017; 23 (05) 465-476
    CrossrefPubMedGoogle Scholar
  • 26 Parthasarathy R, Gupta V, Gupta A. Safety of prasugrel loading in ruptured blister like aneurysm treated with a Pipeline device. Br J Radiol 2018; 91 (1086) 20170476
    CrossrefPubMedGoogle Scholar
  • 27 Chalouhi N, Zanaty M, Tjoumakaris S. et al Treatment of blister-like aneurysms with the pipeline embolization device. Neurosurgery 2014; 74 (05) 527-532 discussion 532
    CrossrefPubMedGoogle Scholar
  • 28 Cerejo R, Bain M, John S. et al Flow diverter treatment of cerebral blister aneurysms. Neuroradiology 2017; 59 (12) 1285-1290
    CrossrefPubMedGoogle Scholar
  • 29 Ray S. Clopidogrel resistance: the way forward. Indian Heart J 2014; 66 (05) 530-534
    CrossrefPubMedGoogle Scholar
  • 30 Mega JL, Close SL, Wiviott SD. et al Cytochrome P450 genetic polymorphisms and the response to prasugrel: relationship to pharmacokinetic, pharmacodynamic, and clinical outcomes. Circulation 2009; 119 (19) 2553-2560
    CrossrefPubMedGoogle Scholar
  • 31 Clemmensen P, Dridi NP, Holmvang L. Dual antiplatelet therapy with prasugrel or ticagrelor versus clopidogrel in interventional cardiology. Cardiovasc Drugs Ther 2013; 27 (03) 239-245
    CrossrefPubMedGoogle Scholar
  • 32 Podlasek A, Al AA Sultan, Assis Z, Kashani N, Goyal M, Almekhlafi MA. Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis. J Neurointerv Surg 2020; 12 (02) 148-155
    CrossrefPubMedGoogle Scholar
  • 33 Limaye K, Zanaty M, Hudson J. et al The safety and efficacy of continuous tirofiban as a monoantiplatelet therapy in the management of ruptured aneurysms treated using stent-assisted coiling or flow diversion and requiring ventricular drainage. Neurosurgery 2019; 85 (06) E1037-E1042
    CrossrefPubMedGoogle Scholar
  • 34 Akbari SH, Reynolds MR, Kadkhodayan Y. Cross DT III, Moran CJ. Hemorrhagic complications after prasugrel (Effient) therapy for vascular neurointerventional procedures. J Neurointerv Surg 2013; 5 (04) 337-343
    CrossrefPubMedGoogle Scholar
  • 35 Bodily KD, Cloft HJ, Lanzino G, Fiorella DJ, White PM, Kallmes DF. Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. Am J Neuroradiol 2011; 32 (07) 1232-1236
    CrossrefPubMedGoogle Scholar
  • 36 Hudson JS, Prout BS, Nagahama Y. et al External ventricular drain and hemorrhage in aneurysmal subarachnoid hemorrhage patients on dual antiplatelet therapy: a retrospective cohort study. Neurosurgery 2019; 84 (02) 479-484
    CrossrefPubMedGoogle Scholar
  • 37 Heit JJ, Telischak NA, Do HM, Dodd RL, Steinberg GK, Marks MP. Pipeline embolization device retraction and foreshortening after internal carotid artery blister aneurysm treatment. Interv Neuroradiol 2017; 23 (06) 614-619
    CrossrefPubMedGoogle Scholar
  • 38 Manning NW, Cheung A, Phillips TJ, Wenderoth JD. Pipeline shield with single antiplatelet therapy in aneurysmal subarachnoid haemorrhage: multicentre experience. J NeuroInterventional Surg 2019; 11 (07) 694-698
    CrossrefPubMedGoogle Scholar
  • 39 Trivelato FP, Wajnberg E, Rezende MTS. et al Safety and effectiveness of the pipeline flex embolization device with shield technology for the treatment of intracranial aneurysms: midterm results from a multicenter study. Neurosurgery 2020; 87 (01) 104-111
    CrossrefPubMedGoogle Scholar
  • 40 Fang C, Tan H-Q, Han H-J. et al Endovascular isolation of intracranial blood blister-like aneurysms with Willis covered stent. J Neurointerv Surg 2017; 9 (10) 963-968
    CrossrefPubMedGoogle Scholar
  • 41 Hu YC, Chugh C, Mehta H, Stiefel MF. Early angiographic occlusion of ruptured blister aneurysms of the internal carotid artery using the Pipeline Embolization Device as a primary treatment option. J Neurointerv Surg 2014; 6 (10) 740-743
    CrossrefPubMedGoogle Scholar
  • 42 Lin N, Brouillard AM, Keigher KM. et al Utilization of pipeline embolization device for treatment of ruptured intracranial aneurysms: US multicenter experience. J Neurointerv Surg 2015; 7 (11) 808-815
    CrossrefPubMedGoogle Scholar
  • 43 Linfante I, Mayich M, Sonig A, Fujimoto J, Siddiqui A, Dabus G. Flow diversion with pipeline embolic device as treatment of subarachnoid hemorrhage secondary to blister aneurysms: dual-center experience and review of the literature. J Neurointerv Surg 2017; 9 (01) 29-33
    CrossrefPubMedGoogle Scholar