Treatment of blood blister–like aneurysm of the internal carotid artery with stent-assisted coil embolization followed by stent-within-a-stent technique

Case report

Restricted access

✓Ruptured blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA) are potentially dangerous lesions because of the high risk of intraoperative bleeding associated with their wide fragile neck. The authors discuss cases in which BBAs were treated endovascularly during the chronic stage and report a case in which a ruptured BBA of the ICA was successfully treated in the acute phase with stent-assisted coil embolization and a subsequent stent-within-a-stent procedure.

Abbreviations used in this paper:BBA = blood blister–like aneurysm; ICA = internal carotid artery; SAH = subarachnoid hemorrhage.

Article Information

Address correspondence to: Byung Moon Kim, M.D., Department of Diagnostic Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, 108 Pyung-Dong, Jongro-Ku, Seoul 110-746, Republic of Korea. email: bmoon21@hanmail.net.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Studies of an ICA aneuryms before and after treatment. A: Oblique 3D reconstruction of a left ICA angiogram demonstrating a small hemispherical bulge at the anteromedial wall of supra-clinoid portion of the artery. Focal irregularity of the wall just distal to the lesion is also seen. B: Left oblique ICA angiogram obtained after stent-assisted coil embolization followed by a stent-within-a-stent procedure. The image shows a completely occluded aneurysm sac. C: Three-dimensional reconstruction of a left ICA angiogram acquired immediately after endovascular treatment, revealing the occluded aneurysm sac and smoothing of the wall where focal irregularity was noted. The radioopaque stent markers are seen as high attenuation spots along the carotid artery wall. D: Follow-up left ICA angiogram obtained 3 months postoperatively revealing complete occlusion of the aneurysm sac and the smooth wall above the occluded aneurysm sac.

  • View in gallery

    Follow-up angiographic studies acquired 6 months after treatment. The 3D reconstruction (left) and native angiogram (right) demonstrate a radiolucent membrane across the aneurysm neck between the coil mass in the aneurysm sac and the smooth ICA lumen.

References

1

Abe MTabuchi KYokoyama HUchino A: Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 89:4194241998

2

Endo STakaba MOgiichi TKurimoto MNishijima MTakaku A: [Pathological study of intracranial artery dissection with sub-arachnoid hemorrhage.] Surg Cereb Stroke 25:1691761997. (Jpn)

3

Fiorella DAlbuquerque FCDeshmukh VRWoo HHRasmussen PAMasaryk TJ: Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery 59:2913002006

4

Ishikawa TNakamura NHoukin KNomura M: Pathological consideration of a “blister-like” aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery 40:4034061997

5

Islam MSManabe HHasegawa STakamura ANagahata M: Successful staged treatment for ruptured blister-like dissecting aneurysm of the intracranial internal carotid artery: acute GDC embolization for the blister-like aneurysm followed by proximal occlusion with extracranial-intracranial bypass in the chronic stage. Minim Invasive Neurosurg 47:1651682004

6

McNeely PDClarke DBBaxter BVandorpe RAMendez I: Endovascular treatment of a “blister-like” aneurysm of the internal carotid artery. Can J Neurol Sci 27:2472502000

7

Nakagawa FKobayashi STakemae TSugita K: Aneurysms protruding from dorsal wall of the internal carotid artery. J Neurosurg 65:3033081986

8

Ogawa ASuzuki MOgasawara K: Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery 47:5785862000

9

Satoh ANakamura HOdaki MKobayashi SKageyama YFukuda K: [High risk aneurysms of the internal carotid artery: dorsal IC aneurysms.]. Surg Cereb Stroke 21:4674721993. (Jpn)

10

Stanson AWKazmier FJHollier LHEdwards WDPairolero PCSheedy PF: Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathological correlations. Ann Vasc Surg 1:15231986

11

Suzuki JOhara H: Clinicopathological study of cerebral aneurysms. Origin, rupture, repair, and growth. J Neurosurg 48:5055141978

12

Tanoue SKiyosue HMatsumoto SYamashita MNagatomi HMori H: Ruptured “blisterlike” aneurysm with a pseudoaneurysm formation requiring delayed intervention with endovascular coil embolization. Case report. J Neurosurg 101:1591622004

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 126 126 34
Full Text Views 144 144 6
PDF Downloads 108 108 7
EPUB Downloads 0 0 0

PubMed

Google Scholar