Treatment of Blood Blister-like Aneurysms with Stent-Assisted Coiling: A Retrospective Multicenter Study

To clarify safety and efficacy of stent-assisted coiling for treatment of blood blister-like aneurysm (BBA) in a multicenter experience.

A total of 212 consecutive cases (213 BBAs) treated with stent-assisted coiling were retrospectively reviewed and included in the final analysis. Outcomes including complete occlusion, recurrence, perioperative morbidity and mortality, and overall good neurologic outcome during follow-up were analyzed.

Of 212 patients, 102 (48.1%) were treated with a single stent, 77 (36.3%) were treated with 2 stents, and 33 (15.6%) were treated with ≥3 stents. Angiographic follow-up data were available for 96 BBAs; 64.6% of BBAs showed complete obliteration, and 22.9% showed recurrence. Complete obliteration rates of patients treated with single, 2, and ≥3 stents were 42.9%, 78.4%, and 88.2%. Recurrence rates of patients treated with single, 2, and ≥3 stents were 38.1%, 13.5%, and 5.9%. Using ≥2 stents seemed to result in higher obliteration rates (P < 0.001) and lower recurrence rates (P = 0.002). Clinical follow-up data available for 180 patients showed 91.1% of patients had a good clinical outcome. No difference was found between the 3 stent treatments. There were 14 (6.6%) perioperative ischemic complications and 12 (5.7%) hemorrhagic complications, with 10 (4.7%) cases of perioperative deaths. Using ≥2 stents seemed to result in a lower perioperative hemorrhagic complication rate compared with single stent (P = 0.037).

Our data support the use of overlapping (≥2) stents combined with coiling as a safe and effective therapeutic modality for BBA. Overlapping (≥2) stents may provide higher obliteration rate, lower recurrence rate, and lower perioperative hemorrhagic risk in treatment of BBA.