2022 Volume 50 Issue 5 Pages 386-391
Treatment of a blood blister-like aneurysm (BBA) of the internal carotid artery (ICA) is challenging in terms of preservation of the anterior choroidal artery (AChA), particularly when it is located distal to the posterior communicating artery of the ICA (C1 portion). A 40-year-old man presented with a subarachnoid hemorrhage caused by BBA rupture at the C1 portion of the ICA, which is at the level of origin of the AChA. The aneurysm was carefully clipped during the first surgery. Computed tomography angiography performed immediately after the operation showed aneurysmal resolution. However, on postoperative day 8, angiography revealed that the aneurysm had recurred. In the second operation, to preserve the AChA originating at the level of the BBA, the aneurysm was treated by ligation of the cervical ICA with high-flow bypass. Postoperative angiography revealed aneurysmal resolution with AChA preservation. The postoperative course was uneventful, and no ischemic complications were observed. Although ICA trapping with bypass is a curative treatment for ICA-BBA, it may lead to severe ischemic complications, especially when the origin of the AChA is involved. BBA curability is controversial; however, proximal ICA ligation with high-flow bypass is an effective treatment for BBA involving a critical perforator such as the AChA.
