Long-Term Clinical and Angiographic Outcomes of Wrap-Clipping for Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery Using Advanced Monitoring

• Published in: World neurosurgery Vol. 126; pp. e439 - e446
• Main Authors: Hanihara, Mitsuto, Yoshioka, Hideyuki, Kanemaru, Kazuya, Hashimoto, Koji, Shimizu, Masahiro, Nishigaya, Kazuyuki, Fukamachi, Akira, Kinouchi, Hiroyuki
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2019
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured - surgery; Blood blister-like aneurysm; Carotid Artery, Internal, Dissection - surgery; Female; Humans; Internal carotid artery; Intracranial Aneurysm - surgery; Male; Middle Aged; Polytetrafluoroethylene; Retrospective Studies; Surgical Instruments; Treatment Outcome; Vascular Surgical Procedures - instrumentation; Vascular Surgical Procedures - methods; Wrap-clipping; BBA; Polytetrafluoroethylene; Blood blister-like aneurysm; AChA; ICA; PTFE; mRS; Wrap-clipping; 3D; CTA; DSA; Internal carotid artery; MEP; SAH
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.02.070

Wrap-clipping is one of the recommended treatments for ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA). However, the long-term clinical and angiographic outcomes of this procedure have not yet been elucidated. The present study examined the long-term efficacy of wrap-clipping using a polytetrafluoroethylene membrane, an ideal wrapping material, for BBAs.
The data from 9 patients with ruptured BBAs treated at our institutes from 2007 to 2016 were retrospectively analyzed. Wrap-clipping was performed with advanced monitoring techniques, including fluorescence video angiography and endoscopy. Angiographic follow-up was achieved using 3-dimensional computed tomography angiography or digital subtraction angiography. Clinical outcomes were assessed using the modified Rankin scale.
Wrap-clipping was performed without any permanent morbidity in all patients. Endoscopy visualized accurate margins of the aneurysmal pathological wall with high magnification and revealed the position of the clip blades and the surrounding perforators in the dead angles of the microscope. Fluorescence video angiography could confirm the blood flow of the ICA and the surrounding arteries. Regrowth of the aneurysm owing to the presence of a neck remnant occurred 1 month after treatment in 1 case that was repaired surgically. However, no other recurrence of BBAs or progression of ICA stenosis was observed by angiography with a mean follow-up period of 37 months. No repeat rupture or ischemic complications occurred, and all patients had a modified Rankin scale score of 0 with a mean follow-up period of 61 months.
Wrap-clipping using a polytetrafluoroethylene membrane for ruptured BBAs is a useful and acceptable procedure with long-term effectiveness. The effectiveness of this method can be ensured using modern monitoring methods.