Endovascular Trapping for Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery: A Case Report and Review of the Literature

Abstract

Rupture of blood blister-like aneurysm (BBA) of the internal carotid artery (ICA) may result in fatal subarachnoid hemorrhage (SAH). Open surgery including bypass surgery has been performed to treat the aneurysm. Recently, endovascular treatment is developing for the treatment of cerebral aneurysm. Here, we report a case of ruptured BBA of the ICA, treated by endovascular trapping and review the literatures.Case Presentation: A 37-year-old woman was brought to our hospital to treat SAH. Computed tomography (CT) angiography showed no apparent cause of the hemorrhage except for the minor dilation of the C2 portion of the left ICA.After 3 days, the CT angiography demonstrated progression of the dilation with the formation of a bleb. Evaluating collateral circulation through anterior communicating artery, endovascular trapping of the ICA was performed. Although she suffered minor ischemic stroke postoperatively, the symptoms recovered completely and discharged without neurological deficit.Review of Literatures: we reviewed the 11 cases of ruptured BBA treated by endovascular trapping. The results of ICA occlusion based on the evaluation of collateral circulation were satisfactory because rebleeding as well as regrowth of the aneurysm were prevented. However, hemodynamic compromise and treatment for vasospasm following SAH are considered. Conclusion:Rebleeding from BBA of the ICA should be prevented first and ischemic complication is avoided secondary.Endovascular trapping following evaluation of the collateral circulation is definitive treatment of BBA of the ICA. Keywords▶ internal carotid artery aneurysm, anterior wall blister-like aneurysm, subarachnoid hemorrhage, endovascular parent artery occlusion 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

“…Peitz et al 22) also mentioned that the deconstructive technique is associated with a higher complication rate than the reconstructive technique. Hayashi et al 23) reported a case where a parent artery occlusion was performed for BBA rupture. The patient recovered completely despite minor ischemic complications.…”