Dorsal Wall Aneurysm Research Articles

Stent-assisted coiling of unruptured paraclinoid aneurysms with wide neck or unfavorable dome-to-neck ratio: Results of ventral wall vs dorsal wall with propensity score matching analysis.

This study aimed to evaluate the clinical safety and efficacy of stent-assisted coil embolization of unruptured wide-necked paraclinoid aneurysms based on the projection distribution. Between November 2015 and September 2020, 267 unruptured paraclinod aneurysms in 236 patients were identified with a wide neck or unfavorable dome-to-neck ratio and treated with stent-assisted coiling technique. The classification of this segment aneurysms was simplified to the dorsal group (located on the anterior wall) and ventral group (Non-dorsal). Following propensity score matching analysis, the clinical and radiographic data were compared between the two groups. Among 267 aneurysms, 186 were located on the ventral wall and 81 were on the dorsal wall. Dorsal wall aneurysms had a larger size (p < .001), wider neck (p = .001), and higher dome-to-neck ratio (p = .023) compared with ventral wall aneurysms. Propensity score-matched analysis found that dorsal group had a significantly higher likelihood of unfavorable results in immediate (residual sac, 39.4% vs. 18.2%, p = .007) and follow-up angiography (residual sac, 14.8% vs. 1.9%, p = .037) compared with ventral group, with significant difference in recurrence rates (9.3% vs. 0%, p = .028). The rates of procedure-related complications were not significantly different, but one thromboembolic event occurred in the dorsal group with clinical deterioration. Traditional stent-assisted coiling can be given preference in paraclinoid aneurysms located on the ventral wall. The relatively high rate of recurrence in dorsal wall aneurysms with stent assistance may require other treatment options.

Pathogenesis of dorsal internal carotid artery wall aneurysms based on histopathologic examination and microscopic configuration

Blood blister-like aneurysms (BBAs) are an important cause of subarachnoid hemorrhage (SAH), but proper treatment is uncertain due to the poor prognosis of these aneurysms. The pathogenesis of BBAs remains unclear and few studies have reported on histological examinations of BBAs because it is difficult to obtain a specimen due to a high risk of intraoperative bleeding.In this report, BBAs were histopathologically examined in two patients who presented with SAH due to rupture of a BBA that was treated with surgical trapping and bypass surgery. BBA specimens including the adjacent internal carotid artery (ICA) walls were obtained intraoperatively.We suggest the pathogenesis of BBAs based on histopathologic examination and microscopic configuration.

The Blood Blister Like-aneurysm: Usefulness of Sundt Clip.

ObjectiveBlood blister-like aneurysm (BBA) is a kind of dorsal wall aneurysm and it is small, sessile, fragile and hazardous because of its high mortality and morbidity. Many challenges tried to establish the management or strategy. But so far, there is no optimal treatment of choice for the BBA. In this article, 17 cases of the ruptured BBA in one institute were analyzed retrospectively. The operative options were correlated with surgical and clinical outcomes.Materials and MethodsDuring 14 years between October, 2002 and October, 2016, 23 patients were treated for subarachnoid hemorrhage with ruptured dorsal wall aneurysms. There were various strategies for treatment and different outcomes revealed. BBA were 17 (74%) cases and 6 (26%) cases were saccular aneurysm. By excluding saccular aneurysm, BBA was sorted and classified with its morphological characteristics, and the outcome of treatment in each case investigated retrospectively.ResultsAmong 17 BBA-cases, 8 cases get microsurgical operation by Sundt clip. 5 cases get operation by conventional Yasargil clip, 1 case treated by Yasargil clip with wrapping, and 2 cases underwent endovascular management with coiling, and 1 case was managed by endovascular trapping of involved internal cerebral artery. Clinical outcomes were analyzed with modified Rankin Scale, Glasgow outcome scale and post-operative complications.ConclusionAs the optimal management, operation using Sundt clip had much significance in treatment BBA. And, a thorough analysis of the angiography is essential to prepare for the treatment of BBA.

Microsurgical techniques for dorsal wall aneurysms in the internal carotid artery

To seek a reasonable microsurgical technique for dorsal wall aneurysms in the internal carotid artery (ICA), and to evaluate its efficacy. Methods: A total of 21 patients with dorsal wall aneurysms in the ICA who received microsurgical techniques were retrospectively analyzed. The directive surgical clapping was applied for saccular aneurysm, while the techniques of stitching and wrapping, simple wrapping, and trapping with extracranial-intracranial bypass were used for cystic and blood blister false aneurysms. Results: One patient died after operation, 1 patient suffered rebleeding and gave up treatment, the remaining 19 patients achieved saticfactory outcomes. Conclusion: According to types of aneurysm wall, the different microsurgical treatments should be applied, and good outcomes can be achieved for patients with dorsal wall aneurysms in the ICA.

O-031 Comparison of techniques for stent-assisted coil embolization of aneurysms

IntroductionStent assisted coiling (SAC) of aneurysms has been adopted with potential mechanical, hemodynamic and biologic properties imparting an advantage over coil embolization alone. Several strategies have emerged within the technique...

Ruptured symptomatic internal carotid artery dorsal wall aneurysm with rapid configurational change. Clinical experience and management outcome: an original article

Aneurysms located at non-branching sites, protruding from the dorsal wall of the supraclinoid internal carotid artery (ICA) with rapid configurational changes, were retrospectively reviewed in effort to identify and characterize these high-risk aneurysms. A total of 447 patients with 491 intracranial aneurysms were treated from March 2005 to August 2008, and of these, eight patients had ICA dorsal wall aneurysms. Four of them suffered subarachnoid hemorrhage (SAH), and all had aneurysms undergoing rapid configuration changes during the treatment course. Digital subtraction cerebral angiography (DSA) performed soon after the SAH events. Data analyzed were patient age, sex, Hunt and Kosnik grade, time interval from first DSA to second DSA, aneurysm treatment, and modified Rankin scale score after treatment for 3 months. Success or failure of therapeutic management was examined among the patients. Digital subtraction cerebral angiography showed only lesions with small bulges in the dorsal walls of the ICAs. However, the patients underwent DSA again for re-bleeding or for post-treatment follow-up, confirming the SAH source. ICA dorsal wall aneurysms with rapid growth and configurational changes were found on subsequent DSA studies. Among the four patients, ICA dorsal wall aneurysms underwent rapid growth with configurational change from a blister type to a saccular type despite different management. ICA trapping including the lesion segment can be considered as the first treatment option if the balloon occlusion test (BOT) is successful. If a BOT is not tolerated by the patient, extracranial-intracranial bypass revascularization surgery with endovascular ICA occlusion is another treatment option.

Ruptured internal carotid artery dorsal wall aneurysm; its clinical features and treatment

Ruptured internal carotid artery dorsal wall aneurysm; its clinical features and treatment

Bilateral Acute Subdural Hematomas With Intracerebral Hemorrhage Without Subarachnoid Hemorrhage, Caused by Rupture of an Internal Carotid Artery Dorsal Wall Aneurysm -Case Report-

A 45-year-old man presented with bilateral acute subdural hematomas (ASDHs) without subarachnoid hemorrhage (SAH). He was found comatose in a parked car. Computed tomography showed left frontal intracerebral hemorrhage (ICH) and bilateral ASDHs but no signs of SAH. Magnetic resonance angiography demonstrated an internal carotid artery dorsal wall aneurysm. Emergent surgical intervention was performed. However, he died of cerebral herniation 6 days later. We inferred that massive intracranial bleeding might have ruptured through the cortex and lacerated the arachnoid membrane. Aneurysm rupture generally results in unilateral SDH, whereas trauma is the usual cause of bilateral ASDHs with ICH. Our case suggests that ruptured aneurysm should be considered in patients with non-traumatic bilateral ASDHs without SAH.

Internal carotid artery dorsal wall aneurysm with configurational change: are they all false aneurysms?

Background Aneurysms arising from nonbranching sites of the ICA, so-called dorsal wall aneurysm, are rare entity, and present as blister type or saccular type. Occasionally configurational changes have been observed on serial cerebral angiography: a small blister-like bulge on ICA wall on initial angiography progressing to a saccular appearance within a few weeks. Such aneurysm showing configurational change has been regarded as a false aneurysm with fragile wall just like blister-type aneurysm, and direct surgical approach has been considered highly risky. Case Description A 42-year-old woman with a subarachnoid hemorrhage revealed small “blister-like” aneurysm at the medial wall of the ICA on initial angiography. After 12 days, the following angiograms demonstrated increased aneurysmal size and change of shape into a saccular configuration. Direct surgical approach was performed. The aneurysm had a relatively firm neck, and was successfully clipped without intraoperative rupture. The dome of aneurysm was resected after clipping and the histologic examination revealed it as a true aneurysm. Conclusions This case suggests that all dorsal wall aneurysms with configurational change are not false aneurysms, and that angiographic findings do not always correlate with the nature of the aneurysmal wall; therefore, we should give more credence to direct surgical observation rather than preoperative angiographic findings when considering the most suitable surgical option.

Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms.

Aneurysms at nonbranching sites in the supraclinoid internal carotid artery (ICA), known as blood blister-like aneurysms or ICA anterior or dorsal wall aneurysms, are not well understood. To clarify this clinical entity, 7408 patients with subarachnoid hemorrhage who were treated during a 5-year period were analyzed. Forty-eight patients had aneurysms that were intraoperatively confirmed to be located at a nonbranching site in the supraclinoid portion of the ICA. Neuroradiological and clinicopathological features and outcomes were studied. The aneurysms were divided into the "blister type," with a blood blister-like configuration and fragile walls, and the "saccular type," with a saccular configuration and a relatively firm neck, like ordinary berry aneurysms. The most frequent origin was the anteromedial wall for both types. ICA dissection was associated only with the blister type, and hypertension was more frequent with the blister type (P = 0.0978). The preoperative conditions of the patients were the same, but the outcomes for patients with blister-type aneurysms were worse, because of frequent intra- and postoperative aneurysmal bleeding. Saccular-type aneurysms were safely clipped. Treatment of blister-type aneurysms by clipping on wrapping material achieved good results, but ICA trapping (P = 0.0952), clipping (P = 0.0146), and wrapping (P = 0.0110) were associated with much worse results. Blister-type and saccular-type aneurysms have different shapes and wall characteristics. The saccular type can be treated by clipping, whereas the blister type requires clipping on wrapping material. ICA trunk aneurysms may be a better designation to express the diversity of these aneurysms, rather than ICA blood blister-like or anterior or dorsal wall aneurysms.

クモ膜下出血例における動脈解離の病理形態

An intracranial artery dissection has been recognized as a proper and definite clinical entity associated with subarachnoid hemorrhage (SAH), but true clinicopathological features of this disease have not been adequately elucidated. In this study, we investigated the pathological features ith angiographic correlates of 10 autopsied cases of an intracranial artery dissecting aneurysm and related lesions with SAH, including a case of dorsal wall aneurysm of the internal carotid artery or unknown-origin SAH.Pathological study revealed that all 10 patients had a ruptured site on the lateral wall of the basal artery, and these lesions were classified into the following 3 categories: 1) fusiform dilatation, 2) lateral protrusion, 3) no dilatation. Three lesions of “fusiform dilatation” formed anenlarged aneurysm with false lumen and were thought to be a typical dissecting aneurysm. Four lesions of “lateral protrusion,” including ICA dorsal aneurysm, had no false lumen and formed a pseudoaneurysm at the arterial wall not related to the arterial divisions. Three other lesions of “no dilatation” were clinically diagnosed as SAH of unknown origin, although angiographic finding of diffuse narrowing was oberved at the ruptured site. Intra-wall dissecting hemorrhage without luminal connection was histopathologically identified as an origin of SAH.Some characteristic information revealed in the previous reports was included in this classification, and good correlation between the pathological features and angiographic findings was seen. We conclude that this classification should be useful in discussions of the various clinicopathological subjects of the intracranial artery dissection.