Background: Blood blister-like aneurysms (BBLA) are rare, challenging to treat, and prone to rerupture. We analyzed our results in relationship to type of BBLA and other prognostic factors.
Methods: Data on patient and aneurysm characteristics, clinical course, and treatment results, including data from patient records and review of imaging findings, were collected prospectively and analyzed retrospectively.
Results: There were 27 patients (mean age 56 years) with subarachnoid hemorrhage from BBLA. Of patients, 13 (48%) had BBLA of the internal carotid artery, 6 had BBLA of the anterior cerebral artery (22%), 5 had BBLA of the middle cerebral artery (19%), and 3 had BBLA of the basilar artery (11%). Most patients (n = 12) had a circumferential type IV BBLA (44%). BBLAs were treated by clip-reinforced wrapping in 13 patients (48%) and by clipping alone in 8 patients (30%); 3 (11%) patients received no treatment. The 3 remaining patients were treated endovascularly, by combined treatment, or by fenestration tube technique. Rerupture after treatment occurred in 4 patients (15%), all of whom had type IV BBLAs. Outcome was unfavorable (modified Rankin scale score 3-6) in 52% (n = 14). The highest rates of rerupture (33%), delayed infarctions (67%), unfavorable outcome (75%), and death (50%) were identified in type IV BBLAs; type I-III BBLAs had a better course.
Conclusions: Treatment of BBLA is challenging. Patients with type IV BBLAs were especially prone to rerupture, delayed infarctions, unfavorable outcomes, and death. Independent risk factors for unfavorable outcome were advanced age (≥60 years) and type IV BBLA.
Keywords: Blister-like aneurysm; Cerebral aneurysm; Clipping; Coiling; Morphology; Recanalization; Subarachnoid hemorrhage.
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