Endovascular treatment of blood blister-like aneurysms of the internal carotid artery

Objective To investigate the feasibility and effectiveness of stent-assisted coil embolization for the treatment of blister-like aneurysms (BBAs) of the internal carotid artery. Methods Eighteen patients with internal carotid BBAs treated with stent-assisted coil embolization and admitted to the Department of Neurosurgery, Hainan Provincial People's Hospital from March 2012 to March 2016 were enrolled retrospectively. The modified Rankin Scale (mRS) score was used to evaluate the clinical outcomes. Results Subarachnoid hemorrhage was seen on CT in all patients. One BBA was located in C5, 8 in C6, 4 in C6-7, and 5 in C7. The mean maximum diameter of BBAs was ≤3 mm. The wall of the aneurysm or the parent artery was irregular. Preoperative Hunt-Hess grades: grade Ⅱ in 13 cases, grade Ⅲ in 4 cases, and grade Ⅳ in 1 case. All patients were treated with stent-assisted coil embolization. Four patients selected Enterprise+ LVIS stents, 1 selected Enterprise stents, and the remaining patients selected LVIS stents. All patients were treated with 2 stents. Postoperative angiography showed complete embolization. One of them relapsed after treatment with simple coil embolization in the other hospital. He was successfully discharged after a second stent-assisted coil embolization and had a good outcome. All patients had no intraoperative or perioperative complications. The patients were followed up for 3 to 18 months. The average follow-up period was 12 months. The mRS score was 0 to 1 in 17 cases, and 2 in 1 case. Conclusion Stent-assisted coil embolization is a safe and effective method for the treatment of BBAs of the internal carotid artery. Key words: Intracranial Aneurysm; Aneurysm, Ruptured; Carotid Artery, Internal; Subarachnoid Hemorrhage; Endovascular Procedures; Stents; Treatment Outcome