{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:41Z","timestamp":1787025761869,"version":"build-2736575974"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Ruptured blister aneurysms remain challenging lesions for treatment due to their broad, shallow anatomy and thin, fragile wall. Historical challenges with both open microsurgical approaches and intrasaccular endovascular approaches have led to increased use of flow diversion for management of these aneurysms. However, the optimum paradigm, including timing of treatment, use of dual antiplatelet therapy, and number of flow-diverter devices to use remains unknown. The authors describe their experience with ruptured blister aneurysms treated with flow diversion at their institution, and discuss rates of rebleeding and number of devices used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>All patients presenting with subarachnoid hemorrhage from a ruptured blister aneurysm and treated with Pipeline flow diversion were identified. Patient demographic data, clinical status and course, need for external ventricular drain (EVD), timing of treatment, and angiographic details and follow-up were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>There were 13 patients identified (11 women and 2 men), and 4 had multiple aneurysms. Two aneurysms were treated on initial angiography, with average time to treatment of 3.1 days for the remainder, after discussion with the family and institution of dual antiplatelet therapy. Device placement was technically successful in all patients, with 2 patients receiving 2 devices and the remainder receiving 1 device. There was 1 intraoperative complication, of a wire perforation causing intracerebral hemorrhage requiring decompressive craniectomy. Three patients had required EVD placement for management of hydrocephalus. There was no rebleeding from the target lesion; however, one patient had worsening intraventricular hemorrhage and another had rupture of an unrecognized additional aneurysm, and both died. Of the other 11 patients, 10 made a good recovery, with 1 remaining in a vegetative state. Nine underwent follow-up angiography, with 5 achieving complete occlusion, 2 with reduced aneurysm size, and 2 requiring retreatment for aneurysm persistence or enlargement. There were no episodes of delayed rupture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Pipeline flow diversion is a technically feasible and effective treatment for ruptured blister aneurysms, particularly in good-grade patients without hydrocephalus. Patients with a worse grade on presentation and requiring EVDs may have higher risk for bleeding complications and poor outcome. There was no rebleeding from the target lesion with use of a single device in this series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2017.3.focus1757","type":"journal-article","created":{"date-parts":[[2017,6,1]],"date-time":"2017-06-01T03:36:47Z","timestamp":1496288207000},"page":"E11","source":"Crossref","is-referenced-by-count":57,"title":["Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy"],"prefix":"10.3171","volume":"42","author":[{"given":"Robert W.","family":"Ryan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir S.","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Barco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armen","family":"Choulakian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurointerv Surg","first-page":"202","article-title":"Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents","volume":"7","author":"Aydin K","year":"2015","unstructured":"Aydin K, Arat A, Sencer S, Hakyemez B, Barburoglu M, Sencer A, : Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg 7:202\u2013209, 2015"},{"key":"b2","series-title":"Radiology","first-page":"858","article-title":"Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial","volume":"267","author":"Becske T","year":"2013","unstructured":"Becske T, Kallmes DF, Saatci I, McDougall CG, Szikora I, Lanzino G, : Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology 267:858\u2013868, 2013"},{"key":"b3","series-title":"Neurosurgery","first-page":"527","article-title":"Treatment of blister-like aneurysms with the Pipeline Embolization Device","volume":"74","author":"Chalouhi N","year":"2014","unstructured":"Chalouhi N, Zanaty M, Tjoumakaris S, Gonzalez LF, Hasan D, Kung D, : Treatment of blister-like aneurysms with the Pipeline Embolization Device. Neurosurgery 74:527\u2013532, 2014"},{"key":"b4","series-title":"Neuroradiology","first-page":"441","article-title":"Endovascular treatment of ruptured blister-like aneurysms with special reference to the flow-diverting strategy","volume":"55","author":"\u00c7inar C","year":"2013","unstructured":"\u00c7inar C, Oran \u0130, Bozkaya H, Ozgiray E: Endovascular treatment of ruptured blister-like aneurysms with special reference to the flow-diverting strategy. Neuroradiology 55:441\u2013447, 2013"},{"key":"b5","series-title":"AJNR Am J Neuroradiol","first-page":"271","article-title":"Pipeline Embolization Device in aneurysmal subarachnoid hemorrhage","volume":"34","author":"Cruz JP","year":"2013","unstructured":"Cruz JP, O\u2019Kelly C, Kelly M, Wong JH, Alshaya W, Martin A, : Pipeline Embolization Device in aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol 34:271\u2013276, 2013"},{"key":"b6","series-title":"J Neurointerv Surg [epub ahead of print]","article-title":"Thrombogenicity of flow diverters in an ex vivo shunt model: effect of phosphorylcholine surface modification","author":"Hagen MW","year":"2016","unstructured":"Hagen MW, Girdhar G, Wainwright J, Hinds MT: Thrombogenicity of flow diverters in an ex vivo shunt model: effect of phosphorylcholine surface modification. J Neurointerv Surg [epub ahead of print], 2016"},{"key":"b7","series-title":"J Neurointerv Surg","first-page":"740","article-title":"Early angiographic occlusion of ruptured blister aneurysms of the internal carotid artery using the Pipeline Embolization Device as a primary treatment option","volume":"6","author":"Hu YC","year":"2014","unstructured":"Hu YC, Chugh C, Mehta H, Stiefel MF: Early angiographic occlusion of ruptured blister aneurysms of the internal carotid artery using the Pipeline Embolization Device as a primary treatment option. J Neurointerv Surg 6:740\u2013743, 2014"},{"key":"b8","series-title":"Neurosurgery","first-page":"403","article-title":"Pathological consideration of a \u201cblister-like\u201d aneurysm at the superior wall of the internal carotid artery: case report","volume":"40","author":"Ishikawa T","year":"1997","unstructured":"Ishikawa T, Nakamura N, Houkin K, Nomura M: Pathological consideration of a \u201cblister-like\u201d aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery 40:403\u2013406, 1997"},{"key":"b9","series-title":"J Vasc Interv Neurol","first-page":"14","article-title":"Pipeline Embolization Device for treatment of intracranial aneurysms-the more, the better? A single-center retrospective observational study","volume":"9","author":"Kabbasch C","year":"2016","unstructured":"Kabbasch C, Mpotsaris A, Behme D, Dorn F, Stavrinou P, Liebig T: Pipeline Embolization Device for treatment of intracranial aneurysms-the more, the better? A single-center retrospective observational study. J Vasc Interv Neurol 9:14\u201320, 2016"},{"key":"b10","series-title":"Neurosurgery","first-page":"1026","article-title":"Long-term follow-up of blister aneurysms of the internal carotid artery","volume":"73","author":"Kalani MY","year":"2013","unstructured":"Kalani MY, Zabramski JM, Kim LJ, Chowdhry SA, Mendes GA, Nakaji P, : Long-term follow-up of blister aneurysms of the internal carotid artery. Neurosurgery 73:1026\u20131033, 2013"},{"key":"b11","series-title":"J Neurosurg","first-page":"781","article-title":"Acute extracranial-intracranial bypass using a radial artery graft along with trapping of a ruptured blood blister\u2013like aneurysm of the internal carotid artery. 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Acta Neurochir (Wien) 151:125\u2013130, 2009"},{"key":"b17","series-title":"J Neurointerv Surg","first-page":"29","article-title":"Flow diversion with Pipeline Embolic Device as treatment of subarachnoid hemorrhage secondary to blister aneurysms: dual-center experience and review of the literature","volume":"9","author":"Linfante I","year":"2017","unstructured":"Linfante I, Mayich M, Sonig A, Fujimoto J, Siddiqui A, Dabus G: Flow diversion with Pipeline Embolic Device as treatment of subarachnoid hemorrhage secondary to blister aneurysms: dual-center experience and review of the literature. J Neurointerv Surg 9:29\u201333, 2017"},{"key":"b18","series-title":"J Neurosurg","first-page":"937","article-title":"Risk of hemorrhagic complication associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on dual antiplatelet therapy","volume":"119","author":"Mahaney KB","year":"2013","unstructured":"Mahaney KB, Chalouhi N, Viljoen S, Smietana J, Kung DK, Jabbour P, : Risk of hemorrhagic complication associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on dual antiplatelet therapy. J Neurosurg 119:937\u2013942, 2013"},{"key":"b19","series-title":"Neurosurgery","first-page":"E634","article-title":"Rerupture of a blister aneurysm after treatment with a single flow-diverting stent","volume":"79","author":"Mazur MD","year":"2016","unstructured":"Mazur MD, Taussky P, MacDonald JD, Park MS: Rerupture of a blister aneurysm after treatment with a single flow-diverting stent. 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