• Myeong Jin Kim, Joonho Chung, Yong Sam Shin, and Yong Cheol Lim.
• a Department of Neurosurgery, Gil Medical Center , Gachon University College of Medicine , Incheon , Republic of Korea.
• Neurol. Res. 2019 Jun 1; 41 (6): 562-568.

BackgroundCoil embolization with multiple overlapping stents was performed as an alternative treatment option for blood blister-like aneurysms (BBAs). However, coil placement into the BBAs has the inherent risks of rupture and regrowth. We describe a safe dense coil packing technique into and just proximal of BBAs using a semi-jailing technique for the treatment of BBAs of the internal carotid artery (ICA) and report the long-term clinical outcomes.MethodsThe technique involves the partial deployment of a self-expanding and retrievable stent from the ICA bifurcation to the mid-portion of a BBA followed by coil embolization with gradual unsheathing of the stent from the BBA to its just proximal portion. Seventeen patients were treated using this technique (10 women; mean age, 47.9 ± 11 years; overall mean clinical follow-up period, 42.3 ± 22.8 months). Technique safety and feasibility, and follow-up angiographic results and clinical outcomes (modified Rankin Scale, mRS) were evaluated.ResultsProcedures were successfully applied without any procedure-related complications. Immediate post-treatment angiograms showed total obliteration of the BBAs in all 17 patients. Follow-up angiograms, which were available in 15 (88.2%) patients, showed complete resolution of BBAs. Fourteen (82.4%) of 17 patients achieved favorable clinical outcomes (mRS ≤ 2).ConclusionsForward deployed coil embolization with multiple overlapping stents offers a safe and effective reconstructive endovascular technique for the treatment of the BBAs.

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