Treatment of blood blister-like aneurysms of the internal carotid artery with stent-assisted coil embolization

Objectives

Blood blister-like aneurysms (BBAs) are aneurysms arising from the nonbranching arterial trunk, which are usually small and located at the anterior wall of supraclinoid internal carotid artery. These aneurysms are quite dangerous due to their fragile neck. This paper aims to evaluate the application of stent-assisted coil embolization in the treatment of BBAs.

Methods

A retrospective review of the aneurysm database in our institution identified 8 patients carrying BBAs planned to be treated by stent-assisted coil embolization. The clinical characteristics, angiographic outcome, and follow-up results were reviewed.

Results

Stent-assisted coil embolization was successfully performed in 5 cases (62.5%). Two procedures were treated with sole stent deployment (25%). One patient suffered intra-operative rupture (12.5%) and endovascular trapping was performed. The modified Rankin scale (mRs) score in living patients at discharge was 1 in four cases, 2 in one case, and 3 in one case. Two patients died of post-operative hemorrhage (25%). The mRs score at 9–36 months’ follow-up was 0 in four cases, 1 in one case, and 2 in one case. All patients were followed up angiographically, and regrowth was observed in three patients, who accepted further endovascular treatments.

Conclusion

Stent-assisted coil embolization may probably reduce the mortality, but may not be a cure for all BBAs.