A case of stent-assisted coil embolization for the ruptured blood blister-like aneurysm of the internal carotid artery

Abstract

Purpose: We report a case of a ruptured blood blister-like aneurysm of the internal carotid artery, which was treated with stent-assisted coil embolization using Enterprise VRD. Case: A 70-year-old man was admitted to our hospital because of unconsciousness due to subarachnoid hemorrhage (SAH). WFNS (World Federation of Neurosurgical Societies) SAH grading scale was 4. Head MR angiography and 3D-CT angiography showed a ruptured blood blister-like paraclinoid aneurysm of the left internal carotid artery. On the next day of admission, the patient presented anisocoria. After an emergency ventricular drainage, stent-assisted coil embolization using Enterprise VRD was subsequently performed. Angiography immediately after embolization showed residual aneurysm filling. The modified Rankin Scale score at discharge after about 2 months was 2. The follow-up angiography for 30 months showed progressive occlusion with a tiny neck remnant of the aneurysm and reconstruction of the internal carotid artery. No rerupture occurred during 33 months. Conclusions: Stent-assisted coil embolization can be considered an alternative treatment option for ruptured blood blister-like aneurysms of the internal carotid artery.