Brown Mason A, Guandique Cristian F, Parish Jonathan, McMillan Aubrey C, Lehnert Stephen, Mansour Nassir, Tu Michael, Bohnstedt Bradley N, Payner Troy D, Leipzig Thomas J, DeNardo Andrew J, Scott John A, Cohen-Gadol Aaron A
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery, Indianapolis, IN, United States.
Carolinas HealthCare System, Charlotte, NC, United States.
J Clin Neurosci. 2017 May;39:72-77. doi: 10.1016/j.jocn.2016.12.021. Epub 2017 Jan 11.
Blister aneurysms at non-branching sites of the dorsal internal carotid artery (dICA) are fragile, rare, and often difficult to treat. The purpose of this study is to address the demographics, treatment modalities, and long-term outcome of patients treated for dICA blister aneurysms. A retrospective review of medical records identified all consecutive patients who presented with a blister aneurysm from 2002 to 2011 at our institution. Eighteen patients (M=7, F=11; mean age: 48.4±15.1years; range: 15-65years) harbored a total of 43 aneurysms, 25 of which were dorsal wall blister aneurysms of the ICA. Eleven (61.1%) patients presented with aneurysmal subarachnoid hemorrhage (aSAH), and 10 (55.6%) patients had multiple aneurysms at admission. Twelve patients had 18 aneurysms that were treated microsurgically. Five (41.7%) of these patients had a single recurrence that was retreated with subsequent repeat clip ligation. Six patients had 7 blister aneurysms that were treated with endovascularly. One (16.7%) of these patients had a single recurrence that was retreated with subsequent coil embolization. Postoperative vasospasm occurred in 8 (44.4%) patients, one of whom suffered from a stroke. This is one of the largest single-institution dICA blister aneurysm studies to date. There was no detected significant difference between microsurgical clip ligation and endovascular coil embolization in terms of surgical outcome. These blister aneurysms demonstrate a propensity to be associated with multiple cerebral aneurysms. Strict clinical and angiographic long-term follow-up may be warranted.
Blister aneurysms are focal wall defects covered by a thin layer of fibrous tissue and adventitia, lacking the usual collagenous layer. Due to their pathologically thin vessel wall, blister aneurysms are prone to rupture. The management of these rare and fragile aneurysms presents a number of challenges. Here, we address the long-term outcome of patients treated for blister aneurysms at non-branching sites of the dICA. The presented data and analysis is imperative to determine the necessary strict long-term clinical and angiographic follow-up.
颈内动脉背侧（dICA）非分支部位的水泡状动脉瘤脆弱、罕见，且治疗往往困难。本研究旨在探讨dICA水泡状动脉瘤患者的人口统计学特征、治疗方式及长期预后。对病历进行回顾性分析，确定了2002年至2011年在我院连续就诊的所有水泡状动脉瘤患者。18例患者（男性7例，女性11例；平均年龄：48.4±15.1岁；范围：15 - 65岁）共患有43个动脉瘤，其中25个为颈内动脉背壁水泡状动脉瘤。11例（61.1%）患者出现动脉瘤性蛛网膜下腔出血（aSAH），10例（55.6%）患者入院时患有多个动脉瘤。12例患者的18个动脉瘤接受了显微手术治疗。其中5例（41.7%）患者出现单次复发，随后再次进行夹闭结扎治疗。6例患者的7个水泡状动脉瘤接受了血管内治疗。其中1例（16.7%）患者出现单次复发，随后进行了弹簧圈栓塞治疗。8例（44.4%）患者术后发生血管痉挛，其中1例发生中风。这是迄今为止最大的单中心dICA水泡状动脉瘤研究之一。在手术效果方面，显微手术夹闭结扎与血管内弹簧圈栓塞之间未发现显著差异。这些水泡状动脉瘤显示出与多个脑动脉瘤相关的倾向。可能需要进行严格的临床和血管造影长期随访。
水泡状动脉瘤是由一层薄纤维组织和外膜覆盖的局灶性壁缺损，缺乏通常的胶原层。由于其病理上较薄的血管壁，水泡状动脉瘤易于破裂。这些罕见且脆弱的动脉瘤的治疗存在诸多挑战。在此，我们探讨了dICA非分支部位水泡状动脉瘤患者的长期预后。所呈现的数据和分析对于确定必要的严格长期临床和血管造影随访至关重要。
