Forward deployed coil embolization with multiple overlapping stents for ruptured blood blister-like aneurysms: technical considerations and outcomes

ABSTRACT

Background: Coil embolization with multiple overlapping stents was performed as an alternative treatment option for blood blister–like aneurysms (BBAs). However, coil placement into the BBAs has the inherent risks of rupture and regrowth. We describe a safe dense coil packing technique into and just proximal of BBAs using a semi-jailing technique for the treatment of BBAs of the internal carotid artery (ICA) and report the long-term clinical outcomes.

Methods: The technique involves the partial deployment of a self-expanding and retrievable stent from the ICA bifurcation to the mid-portion of a BBA followed by coil embolization with gradual unsheathing of the stent from the BBA to its just proximal portion. Seventeen patients were treated using this technique (10 women; mean age, 47.9 ± 11 years; overall mean clinical follow-up period, 42.3 ± 22.8 months). Technique safety and feasibility, and follow-up angiographic results and clinical outcomes (modified Rankin Scale, mRS) were evaluated.

Results: Procedures were successfully applied without any procedure-related complications. Immediate post-treatment angiograms showed total obliteration of the BBAs in all 17 patients. Follow-up angiograms, which were available in 15 (88.2%) patients, showed complete resolution of BBAs. Fourteen (82.4%) of 17 patients achieved favorable clinical outcomes (mRS ≤ 2).

Conclusions: Forward deployed coil embolization with multiple overlapping stents offers a safe and effective reconstructive endovascular technique for the treatment of the BBAs.

KEYWORDS:

• Blood blister–like aneurysm
• stent-assisted coiling
• multiple overlapping stents
• subarachnoid hemorrhage

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Conflict of interests

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Funding

No funding was received for this research.

Notes on contributors

Myeong Jin Kim

Myeong Jin Kim is a neurosurgeon and an assistant professor at Gil Medical Center, Gachon University College of Medicine in Incheon, Korea. He received a master’s degree in medicine from Ajou University in Suwon, Korea. His current fields are neurosurgery and interventional neuroradiology.

Joonho Chung

Joonho Chung is a neurosurgeon and an associate professor at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea. He received a master’s and a doctoral degree in medicine from Inha University in Incheon, Korea. His current fields are neurosurgery and interventional neuroradiology.

Yong Sam Shin

Yong Sam Shin is a neurosurgeon and a professor at Seoul St. Mary’s Hospital, The Catholic University in Seoul, Korea. He received a master’s and a doctoral degree in medicine from Yonsei University in Seoul, Korea. His current fields are neurosurgery and interventional neuroradiology.

Yong Cheol Lim

Yong Cheol Lim is a neurosurgeon and an associate professor at Ajou University Hospital, Ajou University School of Medicine in Suwon, Korea. He received a master’s degree in medicine from Ajou University in Suwon, Korea. His current fields are neurosurgery and interventional neuroradiology.