Skip to main content

Advertisement

SpringerLink
Log in

Endovascular Intervention with a Low-profile Visualized Intraluminal Support Stent Versus Surgical Clipping for Blood Blister-like Aneurysms

A Retrospective Study

  • Original Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

Blood blister-like aneurysms (BBAs) have a high risk of early recurrence and postoperative rebleeding. This study compared the clinical outcomes and complications between endovascular intervention with low-profile visualized intraluminal support (LVIS) stent-assisted coiling and the surgical clipping in patients with BBAs.

Methods

This retrospective study enrolled 39 patients with BBAs who underwent endovascular intervention with LVIS stent-assisted coiling (n = 21) or surgical clipping (n = 18) between January 2013 and July 2018. Primary outcomes were mortality and modified Rankin scale (mRS). Secondary outcomes were hospital stay, intensive care unit (ICU) stay and operation parameters. Complications were also retrospectively collated.

Results

At baseline, the two groups were well balanced in patient characteristics. The hospital stays, ICU stays, operation time and intraoperative infusion volume were all significantly lower in LVIS group than that in clipping group (p < 0.05). A second operation was performed in 6 cases in the clipping group but none in the LVIS group (p = 0.006). The mean mRS score in the LVIS group was significantly lower than that of the clipping group both at hospital discharge and final follow-up (p < 0.001). Adverse outcomes occurred in 1 case in LVIS group and 7 in clipping group, with significant difference (p = 0.015). Complications were reported in 8 cases in LVIS group and 16 cases in clipping group, with significant difference (p < 0.001).

Conclusion

The endovascular intervention with LVIS stent-assisted coiling has better prognosis than surgical clipping. It decreased the risk of a second operation and procedure-related complications compared with surgical clipping.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Szmuda T, Sloniewski P, Waszak PM, Springer J, Szmuda M. Towards a new treatment paradigm for ruptured blood blister-like aneurysms of the internal carotid artery? A rapid systematic review. J Neurointervent Surg. 2016;8:488–94.

    Article  Google Scholar 

  2. 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;47:578–83.

    CAS  PubMed  Google Scholar 

  3. Meling TR, Sorteberg A, Bakke SJ, Slettebo H, Hernesniemi J, Sorteberg W. Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg. 2008;108:662–71.

    Article  Google Scholar 

  4. 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;40:403–5.

    Article  CAS  Google Scholar 

  5. McLaughlin N, Laroche M, Bojanowski MW. Surgical management of blood blister-like aneurysms of the internal carotid artery. World Neurosurg. 2010;74:483–93.

    Article  Google Scholar 

  6. Hao X, Li G, Ren J, Li J, He C, Zhang HQ. Endovascular patch embolization for blood blister-like aneurysms in dorsal segment of internal carotid artery. World Neurosurg. 2018;113:26–32.

    Article  Google Scholar 

  7. Zhu D, Fang Y, Yang P, Zhang P, Chen L, Xu Y, et al. Overlapped stenting combined with coiling for blood blister-like aneurysms: comparison of low-profile visualized Intraluminal support (LVIS) Stent and non-LVIS Stent. World Neurosurg. 2017;104:729–35.

    Article  Google Scholar 

  8. Chen R, Xiao A, Li H, Ma L, Lin S, You C. Blood blister-like aneurysms in tibetans: a retrospective observational study. Clin Neurol Neurosurg. 2017;156:18–23.

    Article  Google Scholar 

  9. Liu Z, Zhang S, Wang S, Chen Q. Management of blood blister-like aneurysms of the internal carotid artery: lessons learned from direct clipping in 22 cases. World Neurosurg. 2017;108:618–26.

    Article  Google Scholar 

  10. Nishi T, Kaji M, Koga K, Yamashiro S, Mizuno T, Hamasaki K, Muta D, Kuratsu JI, Fujioka S. Clipping on crossed wrapping method for ruptured blood blister-like aneurysm of the internal carotid artery: technical note and long-term results. World Neurosurg. 2019;2:100005.

    Article  Google Scholar 

  11. Ji T, Guo Y, Huang X, Xu B, Xu K, Yu J. Current status of the treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery: A review. Int J Med Sci. 2017;14:390–402.

    Article  Google Scholar 

  12. Gonzalez AM, Narata AP, Yilmaz H, Bijlenga P, Radovanovic I, Schaller K, et al. Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol. 2014;83:197–205.

    Article  Google Scholar 

  13. Fang C, Tan HQ, Han HJ, Feng H, Xu JC, Yan S, et al. Endovascular isolation of intracranial blood blister-like aneurysms with Willis covered stent. J Neurointervent Surg. 2017;9:963–8.

    Article  Google Scholar 

  14. Fiorella D, Arthur A, Boulos A, Diaz O, Jabbour P, Pride L, Turk AS, Woo HH, Derdeyn C, Millar J, Clifton A. Final results of the US humanitarian device exemption study of the low-profile visualized intraluminal support (LVIS) device. J Neurointervent Surg. 2016;8:894–7.

    Article  Google Scholar 

  15. Cho YD, Sohn CH, Kang HS, Kim JE, Cho WS, Hwang G, et al. Coil embolization of intracranial saccular aneurysms using the Low-profile Visualized Intraluminal Support (LVIS™) device. Neuroradiology. 2014;56:543–51.

    Article  Google Scholar 

  16. Behme D, Weber A, Kowoll A, Berlis A, Burke TH, Weber W. Low-profile Visualized Intraluminal Support device (LVIS Jr) as a novel tool in the treatment of wide-necked intracranial aneurysms: initial experience in 32 cases. J Neurointervent Surg. 2015;7:281–5.

    Article  Google Scholar 

  17. Feng Z, Fang Y, Xu Y, Hong B, Zhao W, Liu J, et al. The safety and efficacy of low profile visualized intraluminal support (LVIS) stents in assisting coil embolization of intracranial saccular aneurysms: a single center experience. J Neurointervent Surg. 2016;8:1192–6.

    Article  Google Scholar 

  18. Samaniego EA, Abdo G, Hanel RA, Lima A, Ortega-Gutierrez S, Dabus G. Endovascular treatment of PICA aneurysms with a Low-profile Visualized Intraluminal Support (LVIS Jr) device. J Neurointervent Surg. 2016;8:1030–3.

    Article  Google Scholar 

  19. Song J, Oh S, Kim MJ, Chung J, Lim YC, Kim BS, et al. Endovascular treatment of ruptured blood blister-like aneurysms with multiple (〉/=3) overlapping Enterprise stents and coiling. Acta Neurochir (Wien). 2016;158:803-9.

    Article  Google Scholar 

  20. Joo SP, Kim TS, Moon KS, Kwak HJ, Lee JK, Kim JH, Kim SH. Arterial suturing followed by clip reinforcement with circumferential wrapping for blister-like aneurysms of the internal carotid artery. Surg Neurol. 2006;66:424–8.

    Article  Google Scholar 

  21. Yu-Tse L, Ho-Fai W, Cheng-Chi L, Chu-Mei K, Yi-Chou W, Tao-Chieh Y. Rupture of symptomatic blood blister-like aneurysm of the internal carotid artery: clinical experience and management outcome. Br J Neurosurg. 2012;26:378–82.

    Article  Google Scholar 

  22. Rahmanian A, Derakhshan N, Mohsenian Sisakht A, Karamzade Ziarati N, Raeisi Shahraki H, Motamed S. Risk factors for unfavorable outcome in aneurysmal subarachnoid hemorrhage revisited; odds and ends. Bull Emerg Trauma. 2018;6:133–40.

    Article  Google Scholar 

  23. Fang YB, Li Q, Wu YN, Zhang Q, Yang PF, Zhao WY, et al. Overlapping stents for blood blister-like aneurysms of the internal carotid artery. Clin Neurol Neurosurg. 2014;123:34–9.

    Article  Google Scholar 

  24. Tremmel M, Xiang J, Natarajan SK, Hopkins LN, Siddiqui AH, Levy EI, et al. Alteration of intra-aneurysmal hemodynamics for flow diversion using enterprise and vision stents. World Neurosurg. 2010;74:306–15.

    Article  Google Scholar 

  25. Yan Z, Zheng K, Xiong Y, Lan F, Wang Y, Tan X, et al. Intracranial complex ruptured aneurysms coiled with overlapping low-profile visualized Intraluminal support stents: another available option for complex ruptured Intracranial aneurysms. World Neurosurg. 2019;125:e22–8.

    Article  Google Scholar 

  26. Ren Y, Liu L, Sun H, Liu Y, Li H, Ma L, 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:e615–24.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery Critical Care Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, No. 32, West 2nd Section, First Ring Road, Qingyang District, Chengdu, 610072, China

    Ya-Qiu Wu & Min Xu

  2. Department of Neurosurgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, No. 32, West 2nd Section, First Ring Road, Qingyang District, 610072, Chengdu, China

    Li-Zhi Li, Zhen-Yu Wang, Tian Zhang & Mei-Xiong Cheng

Authors
  1. Ya-Qiu Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li-Zhi Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhen-Yu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tian Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Min Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mei-Xiong Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, Y.-Q. Wu; methodology, Y.-Q. Wu and L.-Z. Li; resources, Z.-Y. Wang; data collection and collation, T. Zhang and M. Xu; data analysis: M. Xu; writing, original draft preparation, Y.-Q. Wu; writing, review and editing, L.-Z. Li and M.-X. Cheng; supervision, M.-X. Cheng; project administration, M.-X. Cheng. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mei-Xiong Cheng.

Ethics declarations

Conflict of interest

Y.-Q. Wu, L.-Z. Li, Z.-Y. Wang, T. Zhang, M. Xu and M.-X. Cheng declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, YQ., Li, LZ., Wang, ZY. et al. Endovascular Intervention with a Low-profile Visualized Intraluminal Support Stent Versus Surgical Clipping for Blood Blister-like Aneurysms. Clin Neuroradiol 31, 417–424 (2021). https://doi.org/10.1007/s00062-020-00886-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-020-00886-2

Keywords

Search

Navigation