Abstract
Blood blister-like aneurysm (BBA) is associated with high rebleeding and mortality rates. Treating a ruptured BBA arising from the anterior wall of the internal carotid artery is particularly challenging. Several reports on numerous treatment modalities suggest the following techniques: direct clipping and wrap-clipping, trapping using the extracranial to intracranial bypass (EC-IC bypass), coil embolization, stent-assisted coil embolization, and flow diverting stent. However, there is currently no definite and standard treatment strategy to manage BBA. It is our understanding that certain cases of BBA that permit a clear visualization of the neck of the aneurysm can be treated via direct clipping. Direct clipping is considered the best treatment strategy as it is possible to maintain anterograde blood flow. Furthermore, we can be prepared to regulate unexpected bleeding from the aneurysm and subsequently reduce its internal pressure by positioning an assist balloon directly under the aneurysm. Thereafter, we can successfully dissect and observe the neck of the aneurysm and safely attach a clip to the same. Therefore, a combination of direct clipping and an assist balloon can be considered as a new treatment strategy for BBA.
