Flow diverter embolization device for endovascular treatment of ruptured blister and wide necked very small aneurysms

Mohammad Ghorbani; Christoph J Griessenauer; Christoph Wipplinger; Maziar Azar; Hamidreza Shojaei; Karan Bavand; Darya Khosravi

doi:10.1016/j.heliyon.2019.e02241

Flow diverter embolization device for endovascular treatment of ruptured blister and wide necked very small aneurysms

Heliyon. 2019 Sep 13;5(9):e02241. doi: 10.1016/j.heliyon.2019.e02241. eCollection 2019 Sep.

Authors

Mohammad Ghorbani¹, Christoph J Griessenauer^{2

3}, Christoph Wipplinger⁴, Maziar Azar⁵, Hamidreza Shojaei¹, Karan Bavand¹, Darya Khosravi⁶

Affiliations

¹ Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
² Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.
³ Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
⁴ Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA.
⁵ Department of Neurosurgery, School of Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
⁶ Razi Hospital, Tehran University of Medical Sciences, Iran.

Abstract

Purpose: Ruptured blood blisters (BBA) and very small, wide necked aneurysms (VSA) remain challenging lesions to treat due to their small size, wide necks, and thin, fragile walls. In the present study, we reviewed our experience with these aneurysms treated by flow diversion.

Methods: A total of 18 patients with hemorrhage due to a ruptured BBAs and VSAs, treated with flow diversion between July 2014 and March 2016 were included in this study. We analyzed clinical and radiographic outcomes.

Results: A total of 12 (66.7%) VSAs and 6 (33.3%) BBAs were treated with flow diversion. Fifteen (83.3%) and three (16.7%) aneurysms were located on the internal carotid artery and the basilar artery, respectively. On admission, a GCS score of 15 and WFNS grade 1 were found in 14 (77.7%) patients, 3 patients had an admission GCS of 13 and WFNS grade 2, one had an admission GCS of 8 and WFNS of 4. Fisher CT grades 2, 3, and 4 were observed in 11 (61.1%), 1 (5.6%), and 6 (33.3%) patients, respectively. Flow diversion was performed on average 5.6 days after onset of hemorrhage. 6 months post-intervention angiography showed complete obliteration of the aneurysms in all patients.

Conclusion: Our findings indicate that flow diversion in the acute and subacute phase of hemorrhage is a reliable treatment for reducing complications in patients with BBAs and VSAs. In patients with poor clinical presentation it might be reasonable to delay treatment until the first signs of recovery become apparent.

Keywords: Blood blister aneurysms; Flow diverter devices; Medical imaging; Medicine; Neurology; Neurosurgery; Radiology; Surgery; Very small aneurysms.