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<meta name="DC.Title" content="Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms" />
<meta name="DC.Identifier" content="10.3174/ajnr.A1893" />
<meta name="DC.Date" content="2010-04-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="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.

CTA
:   CT angiography
DSA
:   digital subtraction angiography
ICA
:   internal carotid artery
MIP
:   maximum intensity projections
MPR
:   multiplanar reconstruction
SAH
:   subarachnoid hemorrhage" />
<meta name="DC.Contributor" content="J.R. Gaughen" />
<meta name="DC.Contributor" content="P. Raghavan" />
<meta name="DC.Contributor" content="M.E. Jensen" />
<meta name="DC.Contributor" content="D. Hasan" />
<meta name="DC.Contributor" content="A.N. Pfeffer" />
<meta name="DC.Contributor" content="A.J. Evans" />
<meta name="article:published_time" content="2010-04-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;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).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;" />
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<meta name="twitter:title" content="Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms" />
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<meta name="twitter:description" content="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.

CTA
:   CT angiography
DSA
:   digital subtraction angiography
ICA
:   internal carotid artery
MIP
:   maximum intensity projections
MPR
:   multiplanar reconstruction
SAH
:   subarachnoid hemorrhage" />
<meta name="og-title" property="og:title" content="Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/4/640" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="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.

CTA
:   CT angiography
DSA
:   digital subtraction angiography
ICA
:   internal carotid artery
MIP
:   maximum intensity projections
MPR
:   multiplanar reconstruction
SAH
:   subarachnoid hemorrhage" />
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      <h1 class="highwire-cite-title" id="page-title">Utility of CT Angiography in the Identification and Characterization of Supraclinoid Internal Carotid Artery Blister Aneurysms</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.R. Gaughen</span>, <span class="highwire-citation-author" data-delta="1">P. Raghavan</span>, <span class="highwire-citation-author" data-delta="2">M.E. Jensen</span>, <span class="highwire-citation-author" data-delta="3">D. Hasan</span>, <span class="highwire-citation-author" data-delta="4">A.N. Pfeffer</span> and <span class="highwire-citation-author" data-delta="5">A.J. Evans</span></span></div>
  
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<div id="hw-article-author-popups-top-node-9648--6462633280" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.R. 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<p id="p-3"><strong>BACKGROUND AND PURPOSE:</strong> 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.</p>
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<p id="p-4"><strong>MATERIALS AND METHODS:</strong> 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.</p>
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<p id="p-5"><strong>RESULTS:</strong> 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).</p>
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<p id="p-6"><strong>CONCLUSIONS:</strong> 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.</p>
</div></div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">CTA<span class="def-item-dt-sep"></span></dt><dd>CT angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">DSA<span class="def-item-dt-sep"></span></dt><dd>digital subtraction angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">MIP<span class="def-item-dt-sep"></span></dt><dd>maximum intensity projections<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">MPR<span class="def-item-dt-sep"></span></dt><dd>multiplanar reconstruction<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">SAH<span class="def-item-dt-sep"></span></dt><dd>subarachnoid hemorrhage</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/4/640.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.R.</span> <span class="nlm-surname">Gaughen</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Raghavan</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.E.</span> <span class="nlm-surname">Jensen</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Hasan</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.N.</span> <span class="nlm-surname">Pfeffer</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.J.</span> <span class="nlm-surname">Evans</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">640-644; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1893 </span></div>
  
  
  
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