Blister-like aneurysm of the anterior communicating artery treated with only Low-profile Visualized Intraluminal Support Junior stent
- Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan.
Katsuyoshi Miyashita, Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan.
DOI:10.25259/SNI_923_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Katsuyoshi Miyashita, Kosuke Nambu, Yu Shimizu, Yasuo Tohma. Blister-like aneurysm of the anterior communicating artery treated with only Low-profile Visualized Intraluminal Support Junior stent. 16-Nov-2021;12:564
How to cite this URL: Katsuyoshi Miyashita, Kosuke Nambu, Yu Shimizu, Yasuo Tohma. Blister-like aneurysm of the anterior communicating artery treated with only Low-profile Visualized Intraluminal Support Junior stent. 16-Nov-2021;12:564. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11225
Background: Endovascular treatment is becoming a mainstream treatment for blister-like aneurysms in recent years. Blister-like aneurysms are usually located in the internal carotid artery, whereas that of the anterior communicating artery (AcomA) are very rare. We report the first case of blister-like aneurysm of AcomA that was treated solely with a neck bridging stent that resulted in complete occlusion without complication.
Case Description: A 50- year- old woman was admitted to our hospital due to a subarachnoid hemorrhage. Digital subtraction angiography showed a very small aneurysm in the dorsal side of the AcomA. We considered it a blister-like aneurysm based on its size and shape. She underwent endovascular treatment under general anesthesia on day 15 after vasospasm period. Dual antiplatelet therapy was administrated 1 week prior. A Low-profile Visualized Intraluminal Support Junior stent was implanted from the left A2 to the right A1, covering the AcomA. The postoperative course was uneventful, and she was discharged with no neurological deficit. The aneurysm remained unchanged on postoperative day 14; however, complete occlusion was achieved 3 months after the treatment.
Conclusion: Monotherapy with a neck bridging stent is an effective treatment option for blister-like aneurysms. Treatment with a single stent could achieve complete occlusion especially if the aneurysms occur elsewhere than the internal carotid artery. We should consider immediate additional treatment if the aneurysm grows within 1 month after initial treatment.
Keywords: Anterior communicating artery, Blister- like aneurysm, Neck bridging stent
Blister-like aneurysms are rare subtype that has the characteristics of a wide neck and dissecting appearance. They have a high tendency for perioperative rebleeding due to fragile walls. Most of the blister-like aneurysms are located in non-branching sites of the internal carotid artery.[
Blister-like aneurysms are treated with both microsurgery and endovascular surgery, while there is no optimal therapeutic strategy. In recent years, endovascular treatment is becoming the main approach of treatment for blister-like aneurysms due to the development of techniques and devices for endovascular treatment.[
Blister-like aneurysms of the AcomA are very rare with only ten previously reported cases [
A 50-year-old woman was admitted to our hospital due to a sudden headache. Computed tomography demonstrated diffuse subarachnoid hemorrhage with no laterality [
Endovascular treatment was performed under general anesthesia at day 15. Dual antiplatelet therapy was administrated a week prior. A 6Fr Roadmaster (Goodman, Aichi, Japan) was placed in the right internal carotid artery with the administration of the systemic heparin. Headway 17 (Terumo, Tokyo, Japan) was delivered to the left A2, and 2.5 × 17 mm LVIS Jr. stent was implanted from the left A2 to the right A1 covering AcomA. The LVIS Jr. stent was deployed with wire pushing in order to avoid insufficient expansion. Sufficient expansion and patency of the stent were confirmed [
Postoperative cone beam computed tomography showing the implanted Low-prolife Visualized Intraluminal Support Junior stent from the left A2 to the right A1 covering the anterior communicating artery (a). 3D- RA at 3 months after the treatment demonstrating complete occlusion of the aneurysm (b).
The postoperative course was uneventful and she was discharged with no neurological deficit at day 39 (postoperative day 24). DSA at postoperative day 14 showed that the aneurysm remained unchanged; however, complete occlusion was achieved 3 months after the treatment [
Endovascular treatments for blister-like aneurysms include stent-assisted coiling, stenting alone, and flow diversion.[
Metal coverage ratio of the stent is the most important factor in terms of the flow diversion effect. The approximate metal coverage ratio of the FD is 30%, while that of LVIS, LVIS Jr., Enterprise (Johnson and Johnson Codman, Miami, FL, USA), and Neuroform Atlas (Stryker, Fremont, CA, USA) is 23%, 18%, 11%, 12%, respectively.[
Another treatment option for blister-like aneurysms is direct surgery such as clipping and trapping. In AcomA aneurysms, the most critical concern is the preservation of the hypothalamic artery. Seven cases of AcomA blister-like aneurysm were treated by clipping and intraoperative rupture occurred in two cases among them [
This is the first report of a ruptured blister-like aneurysm of the AcomA treated solely with a stent. Monotherapy with stent for blister-like aneurysms might be an effective treatment with lower rate of complications than direct surgery. Complete occlusion could be expected for blister-like aneurysms with single stent occurring elsewhere than the internal carotid artery. We should consider immediate additional treatment if the aneurysms grow within 1 month after initial treatment.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
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