Double stent-assisted coiling with Neuroform Atlas stents for treating ruptured blood blister-like aneurysms

OBJECTIVE: A ruptured blood blister-like aneurysm (BBA) of the supraclinoid internal carotid artery is a rare but surgically challenging vascular disease. Numerous endovascular approaches have been reported, but optimal management remains controversial. This study aimed to report on our experience and assess the safety and efficacy of our treatment strategy. METHODS: The treatment strategy basically involves stent-assisted coiling using semi-jailing technique followed by stent overlap with Neuroform Atlas stents. Angiographic results (modified Raymond scale), clinical outcomes (modified Rankin Scale), and technical feasibility were evaluated. RESULTS: A total of ten patients with ruptured BBAs were treated via this technique (8 women; mean age, 45.4 years). Procedures were successfully applied without any procedure-related symptomatic complications except one thromboembolism. The immediate angiographic results were complete occlusion in 6 aneurysms, residual neck in 1 aneurysm, and residual sac in 3 aneurysms. Early complementary treatment was required in one. Follow-up angiograms (mean, 9.6 months), which were available in 8 patients, showed complete resolution of BBAs in all, except one who was retreated with a flow diverter. At the end of the observation period (mean, 41.0 months), all patients had excellent clinical outcomes (modified Rankin Scale 0-1), except two with initial poor grade subarachnoid hemorrhage. Conclusions: Double stent-assisted coiling using Neuroform Atlas stents offers a feasible and practical reconstructive option for ruptured BBAs, particularly in healthcare systems where flow diverters are not approved for acute-phase use.