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

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✓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:

© AANS, except where prohibited by US copyright law.



  • 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.



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