Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;163(4):1167-1179.
doi: 10.1007/s00701-020-04697-9. Epub 2021 Jan 11.

Comparison of clinical and histopathological characteristics of short-term progressive and non-progressive blood blister-like aneurysms

Dingke Wen #  1   2 , Ruiqi Chen #  1 , Nicholas W Kieran  2 , Maryam Sharifian-Dorche  2   3 , Wu Liu  4 , Hao Li  1 , Chao You  1 , Mu Yang  5   6 , Lu Ma  7   8
Affiliations

Comparison of clinical and histopathological characteristics of short-term progressive and non-progressive blood blister-like aneurysms

Dingke Wen et al. Acta Neurochir (Wien). 2021 Apr.

Abstract

Background: Many blood blister aneurysms (BBAs) have been documented with a rapid progression history in repeated angiography. The underlying mechanism and clinical significance remained elusive. This current study aims to clarify the clinical and histopathological differences between short-term progressive BBA and non-progressive BBAs.

Methods and materials: Eighty-one patients with BBAs were consecutively included for this single-center retrospective analysis. Clinical and radiological data on these patients were retrieved from 2017 to 2019. BBAs were defined as either progressive or non-progressive based on observed growth based on repeated imaging. Histopathological examinations of a saccular aneurysm, a progressive BBA, and a non-progressive BBA were conducted using representative aneurysm samples.

Results: Among all enrolled patients, 26 of the them were identified with progressive BBAs, while the other 55 with non-progressive BBAs. Progressive BBAs were diagnosed significantly earlier in angiography (3.36 ± 0.61 vs. 6.53 ± 1.31 days, p < 0.05) and showed a higher presence rate of daughter sacs (61.5 vs. 38.2%, p < 0.05). Three different progression patterns were identified. BBAs that developed daughter sac enlargement are diagnosed significantly later than BBAs exhibiting other progression patterns. Patients with progressive and non-progressive BBAs exhibited similar overall clinical outcomes and incidence for complications. For patients with non-progressive BBAs, microsurgery appears to be inferior to endovascular treatment, while for patients with progressive BBAs, the short-term outcomes between microsurgery and endovascular treatment were identical. Histopathological analysis revealed that both subtypes shared a similar pseudoaneurysms structure, but non-progressive BBAs had more histologically destructed aneurysm wall with less remnant fibrillar collagen in adventitia.

Conclusions: Progressive and non-progressive BBAs may not be distinct pathological lesions but represent different stages during the BBA development. Early intervention, regardless of treatment methods, is recommended for salvageable patients with progressive BBAs, but microsurgery should be performed with caution for non-progressive BBAs due to increased surgical risk.

Keywords: Aneurysm progression; Blood blister-like aneurysm; Digital subtract angiography; Intracranial aneurysm; Pathology.

PubMed Disclaimer

References

    1. Abboud T, Rustom J, Bester M, Czorlich P, Vittorazzi E, Pinnschmidt HO, Westphal M, Regelsberger J (2017) Morphology of ruptured and unruptured intracranial aneurysms. World Neurosurg 99:610–617. https://doi.org/10.1016/j.wneu.2016.12.053 - DOI - PubMed
    1. Balik V, Takebayashi S, Takizawa K (2020) A case series of double bypass technique used for the treatment of internal carotid blood blister-like aneurysms in patients in poor initial neurological condition at the early stage of subarachnoid hemorrhage. Oper Neurosurg (Hagerstown, Md) 18:126–135. https://doi.org/10.1093/ons/opz107 - DOI
    1. Bojanowski MW, Weil AG, McLaughlin N, Chaalala C, Magro E, Fournier JY (2015) Morphological aspects of blister aneurysms and nuances for surgical treatment. J Neurosurg 123:1156–1165. https://doi.org/10.3171/2014.11.jns141004 - DOI - PubMed
    1. Catapano JS, Lang MJ, Koester SW, Wang DJ, DiDomenico JD, Fredrickson VL, Cole TS, Lee J, Lawton MT, Ducruet AF, Albuquerque FC (2020) Digital subtraction cerebral angiography after negative computed tomography angiography findings in non-traumatic subarachnoid hemorrhage. J Neurointerventional Surg 12:526–530. https://doi.org/10.1136/neurintsurg-2019-015375 - DOI
    1. Cezar-Junior AB, Viturino U, Vieira de Carvalho EJ, Faquini IV, Almeida NS, Azevedo-Filho HRC (2019) Blister aneurysms of the internal carotid artery: Surgical treatment and management outcome from a single center experience. Clin Neurol Neurosurg 182:136–141. https://doi.org/10.1016/j.clineuro.2019.05.006 - DOI - PubMed

Publication types

LinkOut - more resources