A Patient with a Ruptured Blood Blister-like Aneurysm of the Internal Carotid Artery in Whom Two LVIS Stents Were Inserted

Abstract

We report a case in which multiple overlapping low-profile visualized intraluminal support (LVIS) stents were used as monotherapy for ruptured blood blister-like aneurysm (BBA) of the internal carotid artery (ICA). Case Presentation: A 48-year-old female presented to the emergency room with acute-onset headache. She was alert without neurological deficit with subarachnoid hemorrhage (SAH) Hunt and Kosnik grade I. Emergency angiography revealed a BBA from the supraclinoid ICA. This aneurysm had a small diameter, which makes coil embolization difficult. Therefore, we planned to use multiple overlapping LVIS stents as monotherapy for the ruptured aneurysm. The postoperative course was uneventful without rebleeding. The patient exhibited no neurological deficits on the clinical follow-up at 1 year. Conclusion: Multiple overlapping LVIS stents as monotherapy is useful for ruptured BBAs of the ICA. Keywords▶ subarachnoid hemorrhage, ruptured aneurysm, blood blister-like aneurysm, multiple overlapping stent, low-profile visualized intraluminal support stents This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

Considerations and Literature Review for Treating Subarachnoid Hemorrhage due to Blood Blister-Like Aneurysms

“…The efficacy of overlapping stents has been reported in case reports or treatment results of single institutions by Suzuki et al 6) and Ji et al 7) Lim and Song 15) treated 16 patients with overlapping stents and 1 with SAC. Three of the patients died, whereas 14 achieved CO during the follow-up DSA.…”

“…Yu et al 5) reported 13 patients with BBA between 2004 and 2010 treated using SAC: 6 had no deficit, 3 had ischemic complications, 3 died from rebleeding, and 1 died from a central nervous system infection. 6) Recent articles have also reported the efficacy and safety of SAC. Roh et al 10) reported, using pooled analysis, that the rates of good outcome were 89.9%, rebleeding was 7.94%, recurrence was 24.2%, and the mortality rate was 7.7%.…”

“…Nevertheless, the timing of the intervention remains controversial. There are reports that BBAs should be treated as early as possible to avoid rebleeds, 6 , 7) and the Japan Stroke Society guideline for stroke treatment recommended that ruptured cerebral aneurysms should be treated within 72 h from the onset; however, we waited as long as possible during the acute phase and performed the EVT during the subacute phase. Fujimori et al 25) reported treating 11 patients using EVT in the acute phase.…”

“…Consequently, we used SAC as the first-line treatment for SAH due to BBA. As some articles have mentioned, BBAs should be treated as early as possible to avoid rebleeds 6 , 7) and ruptured cerebral aneurysms should be treated within 72 h from the onset according to Japan Stroke Society guidelines for treating stroke, we waited as long as possible during the acute phase and performed EVT in the subacute phase. Here, we report our case series of such treatment for patients with SAH due to BBA and a literature review.…”