Ahead of Print: Long-Term Follow-up of Blister Aneurysms of the ICA

Screen Shot 2013-11-04 at 12.05.03 PMBackground: Blister aneurysms of the internal carotid artery 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 internal carotid artery 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 (GOS) 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 (Gore Medical, Flagstaff, Arizona, USA) (n=3, 16.7%). There were four cases of intraoperative rupture, all associated with attempted direct clipping; all four cases were successfully clipped. Two cases rebled posttreatment. 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 one case, and in-stent stenosis in two cases. At the mean follow-up of 74.5 months (median, 73; range, 7-165), the mean GOS score was 4.6 (range, 2-5; median, 5).

Conclusion: Microsurgical treatment of blister aneurysms of the internal carotid artery 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.

From: Long-Term Follow-up of Blister Aneurysms of the Internal Carotid Artery by Spetzler et al.

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