Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms

J. R GAUGHEN; P RAGHAVAN; M. E JENSEN; D HASAN; A. N PFEFFER; A. J EVANS

doi:10.3174/ajnr.A1893

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Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms

Journal article

Open access

Peer reviewed

Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms

J. R GAUGHEN, P RAGHAVAN, M. E JENSEN, D HASAN, A. N PFEFFER and A. J EVANS

American journal of neuroradiology : AJNR, Vol.31(4), pp.640-644

2010

DOI: 10.3174/ajnr.A1893

PMID: 19942699

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Abstract

BACKGROUND AND PURPOSE: Blister aneurysms of the supraclinoid ICA represent a rare but potentially catastrophic cause of SAH, often presenting both diagnostic and therapeutic dilemmas. We explore the utility of CTA in the identification and characterization of ICA blister aneurysms. MATERIALS AND METHODS: We performed a retrospective review of catheter cerebral angiograms obtained at our institution over a 12-month period for evaluation of SAH, identifying 6 cases of ICA blister aneurysms. All patients underwent CTA and DSA for evaluation of SAH. The reports from the CTA and DSA studies were reviewed to identify aneurysms correctly diagnosed prospectively. Retrospective review of the CTA and DSA images was also performed. Review of the interpretations and images was performed for any follow-up studies. RESULTS: All 6 patients presented with SAH, diagnosed by head CT. All patients subsequently underwent CTA prior to DSA evaluation. All 6 aneurysms were identified prospectively on initial DSA imaging. Of the 6 blister aneurysms, 4 (67%) were identified prospectively; and 5 (83%), retrospectively on CTA. All 6 patients underwent endovascular treatment with stent placement. Four of the 6 aneurysms underwent follow-up CTA (range, 9–22 days), including the 2 aneurysms that had been unidentifiable preprocedurally. All 4 blister aneurysms were seen postprocedurally by DSA. Three of these 4 (75%) residual aneurysms were detected by CTA (both prospectively and retrospectively). CONCLUSIONS: In the presence of SAH and otherwise negative findings on CTA, a catheter cerebral angiogram should be performed to absolutely exclude an ICA blister aneurysm.

Nervous System

Radiodiagnosis. Nmr imagery. Nmr spectrometry

Biological and medical sciences

Investigative techniques, diagnostic techniques (general aspects)

Medical sciences

Details

Title: Subtitle: Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms
Creators: J. R GAUGHEN - Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, United States
P RAGHAVAN - Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, United States
M. E JENSEN - Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, United States
D HASAN - Department of Neurosurgery, University of Iowa Hospitals and Clinic, Iowa City, Iowa, United States
A. N PFEFFER - University of Virginia School of Medicine, University of Virginia Health System, Charlottesville, Virginia, United States
A. J EVANS - Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, United States
Resource Type: Journal article
Publication Details: American journal of neuroradiology : AJNR, Vol.31(4), pp.640-644
DOI: 10.3174/ajnr.A1893
PMID: 19942699
NLM abbreviation: AJNR Am J Neuroradiol
ISSN: 0195-6108
eISSN: 1936-959X
Publisher: American Society of Neuroradiology; Oak Brook, IL
Language: English
Date published: 2010
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurosurgery; Otolaryngology
Record Identifier: 9984040347302771

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