AneurysmAneurysmal embolization of a blisterlike aneurysm of the internal carotid artery: a case report and review of the literature
Introduction
Blisterlike aneurysms of the supraclinoid ICA have recently been recognized as having unique pathological and clinical features. These are rare types of aneurysms, which have been found to comprise 0.9% to 6.5% of all ICA aneurysms [4]. It is important to recognize this type of aneurysm because of their very fragile nature, high rate of intraoperative and postoperative bleeding, and tendency to progress in size over a short period. Various surgical and endovascular approaches have been described for the treatment of blisterlike aneurysms. However, the optimal treatment strategy remains to be elucidated. To our knowledge, there were few cases of blisterlike aneurysms treated by a GDC. We herein report the case of a blisterlike aneurysm of the ICA treated with GDC embolization on the 19th day of subarachnoid hemorrhage. In addition, the clinical features as well as the therapeutic difficulties in other such cases are also reviewed.
Section snippets
Case report
A 21-year-old man experienced a sudden onset of a severe headache while he was working. Because of a gradual deterioration of consciousness, he was brought to the emergency department of our hospital. The patient presented with unconsciousness but no other neurological deficits. His condition was graded Hunt and Hess grade IV. His medical history was unremarkable other than mental deterioration and no particular medication history. His family history was negative for cerebrovascular disease. CT
Discussion
Generally, blisterlike aneurysms are rare, representing only 0.9% to 6.5% of all ICA aneurysms [4]. In addition, such aneurysms tend to have a worse prognosis than other aneurysms because they are fragile and often rupture prematurely during surgical exposure, thus resulting in a higher morbidity. In previous reports, various surgical procedures have been described for the treatment of such aneurysms [1], [4]. The optimal treatment method is the application of a clip, with the clip blades
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Cited by (19)
Endovascular treatment of ruptured blister-like aneurysms: A case report and review of the literature
2021, Radiology Case ReportsCitation Excerpt :In 2004, Tanoue et al. [10] reported a case of a ruptured BA of the supraclinoid ICA that was successfully treated with coil embolization 40 days after admission. In another report, in 2006, Ezaki et al. [9] reported a case of a ruptured BA, for which DSA images obtained 3 days after hemorrhage revealed a morphological shift in the aneurysm from a BA to a saccular type. After 19 days, the patient underwent coil embolization without complications.
Flow diverter embolization device for endovascular treatment of ruptured blister and wide necked very small aneurysms
2019, HeliyonCitation Excerpt :Many attempts have been made to improve endovascular techniques for the treatment of blister aneurysms. In a study by Ezaki et al. it was reported that despite successful placement of coils could be performed in one case of a blister aneurysm, follow-up evaluation indicated progressive growth and transformation into a saccular aneurysm [16]. Park et al. reported about seven patients with blister aneurysms who were treated with coil embolization.
Ischemic complications after radial artery grafting and aneurysmal trapping for ruptured internal carotid artery anterior wall aneurysm
2012, World NeurosurgeryCitation Excerpt :Other factors include 1) the incidence of intraoperative rupture is high (17, 30, 32); 2) clipping is difficult in many patients (13, 16, 30, 34); and 3) the prognosis of acute stage surgery is poor (2, 16, 30, 32). As a result, studies have been conducted with regard to treatment methods other than clipping (1, 4, 5, 8, 19, 27, 30), such as simple parent artery occlusion of the internal carotid artery (ICA) (20) and stent placement (1, 5). The usefulness of one of these methods, surgery accompanied by revascularization (8, 14, 16, 23, 26, 33, 34), has been reported sporadically.
Treatment of ruptured internal carotid artery trunk aneurysms: Feasibility of endovascular trapping or proximal obliteration of the ICA
2011, Clinical Neurology and NeurosurgeryCitation Excerpt :However, few cases have been reported to date, and this approach has not yet been established as an acute-stage treatment [17]. Endosaccular embolization has been reported as another option [2,8,18–22]. However, Park et al. encountered aneurysmal regrowth in all 4 patients who had undergone endosaccular embolization, and rebleeding after embolization in two cases.
Current status of the treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery: A review
2017, International Journal of Medical Sciences