Fang Yi-Bin, Li Qiang, Wu Yi-Na, Zhang Qi, Yang Peng-Fei, Zhao Wen-Yuan, Huang Qing-Hai, Hong Bo, Xu Yi, Liu Jian-Min
Department of Neurosurgery, Changhai hospital, 168 Changhai Road, Shanghai 200433, PR China.
Department of Neurosurgery, Changhai hospital, 168 Changhai Road, Shanghai 200433, PR China.
Clin Neurol Neurosurg. 2014 Aug;123:34-9. doi: 10.1016/j.clineuro.2014.04.023. Epub 2014 May 14.
Blood blister-like aneurysms (BBAs) are unique due to their high risk of recurrent bleeding associated with their fragile neck. The best treatment for BBAs is still controversial. This paper sought to evaluate the safety and efficacy of stent-assisted coiling and subsequent overlapping stents (SAC+OS) in the treatment of BBAs.
Fifteen consecutive patients with ruptured BBAs managed with SAC+OS were enrolled in this study. The clinical characteristics, procedural data, angiographic outcome, and follow-up results were reviewed.
SAC+OS were successfully performed in all 15 cases. The instant angiographic result was total occlusion in 6 cases, residual neck in 7 cases, and residual aneurysm in 2 cases. Angiographic follow-ups revealed total occlusion in all 6 cases treated by triple or quadruple stents, and 6 of 9 cases treated by double stents. Major recanalization was detected in 3 cases treated by double stents. The modified Rankin Scale score at 4-52 months follow-up (23.8 months on average) was 0 in 6 cases, 1 in 8 cases, and 3 in one case.
Stent-assisted coiling and subsequent overlapping stents are feasible and safe for BBAs. It can be helpful to further decrease the risk of recanalization with more stents. Early angiographic follow-up within 2 weeks is recommended.
血泡样动脉瘤（BBAs）因其颈部脆弱，再出血风险高而独具特点。BBAs的最佳治疗方法仍存在争议。本文旨在评估支架辅助弹簧圈栓塞及后续重叠支架置入术（SAC+OS）治疗BBAs的安全性和有效性。
本研究纳入15例采用SAC+OS治疗的破裂BBAs连续患者。回顾其临床特征、手术数据、血管造影结果及随访结果。
15例均成功实施SAC+OS。即刻血管造影结果显示，6例完全闭塞，7例有残余颈部，2例有残余动脉瘤。血管造影随访显示，三重或四重支架治疗的所有6例均完全闭塞，双重支架治疗的9例中有6例完全闭塞。双重支架治疗的3例检测到主要再通。随访4 - 52个月（平均23.8个月）时，改良Rankin量表评分为0分的有6例，1分的有8例，3分的有1例。
支架辅助弹簧圈栓塞及后续重叠支架置入术治疗BBAs可行且安全。使用更多支架可能有助于进一步降低再通风险。建议在2周内进行早期血管造影随访。
