The application of the Willis covered stent in the treatment of blood blister-like aneurysms: a single-center experience and systematic literature review.

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The application of the Willis covered stent in the treatment of blood blister-like aneurysms: a single-center experience and systematic literature review.

World Neurosurg. 2018 Dec 18;:

Authors: Liu LX, Zhang CW, Xie XD, Wang CH

Abstract
PURPOSE: The purpose of this study is to introduce our initial experience with the use and feasibility of the Willis covered stent (WCS) in the treatment of blood blister-like aneurysms (BBAs) and to present a systematic review of the literature on treatment of BBAs with covered stents.
METHODS: Fourteen consecutive patients with BBAs were treated with WCSs (Microport, Shanghai, China) at West China Hospital from January 2015 to August 2017. Patient medical records, angiography findings, and endovascular treatment reports were reviewed by interventional neuroradiologists and neurosurgeons to obtain relevant clinical and angiographic information. We conducted a systematic review of all reports of BBAs treated with covered stents. We searched the literature using PubMed, Embase, CNKI and Wanfang databases, and commercial internet search engines. We included BBAs located at nonbranching portions of the internal carotid artery.
RESULTS: The current study included nine men and five women with a mean age of 54.5 years (range, 30-79 years). All patients had complete occlusion after immediate postoperative angiography. The ophthalmic artery (OA) was occluded in two patients (14.3%). No mortality or morbidity occurred during the procedure. Two patients (14.3%) experienced mild recurrence. One patient (7.1%) had mild in-stent stenosis. A clinical follow-up of 6 to 15 months was performed in all patients. Eleven patients (78.6%) had mRS score of 0, and one patient (7.1%) had an mRS score of 1 during follow-up. One patient (7.1%) experienced subarachnoid hemorrhage (SAH) and death 7 and 10 days after surgery, respectively. None of the patients experienced visual defects. In this report, thirteen patients (92.9%) survived, as determined by outpatient department visits or telephone interviews. A total of 8 articles including 38 patients met our criteria. Thirty-seven patients (97.3%) had successful delivery to the diseased ICA. Thirty-four (89.5%) patients experienced complete occlusion during follow-up. The overall rate of complete occlusion was 83.0% (95% CI, 68-91%).
CONCLUSION: Patients with ruptured BBAs treated with WCSs achieved satisfactory clinical results. Therefore, for BBAs, the implementation of the WCS may be safe and feasible. This strategy may be a promising option for this type of high-risk aneurysm. However, patients with tortuous ICAs or aneurysms close to essential branch arteries should be carefully evaluated before using the WCS.

PMID: 30576815 [PubMed - as supplied by publisher]

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