Abstract
A small hemispherical bulging from the anterior wall of the internal carotid artery (ICA), which we call a blood blister-like aneurysm (BBA), is a treacherous lesion. Treatment of this lesion requires special tactics. We report the course of patients with this lesion treated by endovascular occlusion of the cervical ICA with or without bypass surgery.
We describe 3 patients with BBAs who presented with subarachnoid hemorrhage (SAH). In these patients, the initial angiogram soon after SAH showed only a small bulging from the anterior wall of the ICA. This bulge progressed to a saccular appearance within a few weeks. Two patients were treated conservatively, and underwent endovascular occlusion of the cervical ICA in the chronic stage, 1 with and the other without STA-MCA anastomosis. One patient underwent direct surgery on the aneurysm in the acute stage; clipping after wrapping with a strip of gauze was performed. Repeated angiogram showed growth of the aneurysm. Endovascular occlusion of the cervical ICA was subsequently performed. All 3 patients did well and returned to their previous life style.
Our experience with these lesions, as well as a review of the literature, suggests that direct clipping often causes laceration of the lesion, and wrapping or clipping after wrapping may fail to prevent growth of the aneurysm. Endovascular occlusion of the cervical ICA with or without bypass surgery, which is less risky than direct surgery, is still useful for this kind of lesion.
