Management of Blood Blister-Like Aneurysms of the Internal Carotid Artery: Lessons Learned from Direct Clipping in 22 Cases

Abstract

Objective: To present a case series of blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) and an assessment of diagnosis and treatment options, attempting to identify surgical or endovascular management of BBAs with a low complication rate and a functional outcome.

Methods: A retrospective analysis including diagnosis and treatment options of BBAs of the ICA was performed of patients treated for BBAs at Fuzhou General Hospital from January 2008 to September 2016.

Results: The case series includes 22 patients (14 women and 8 men) treated by direct clipping. Of all cases, 10 patients were successfully clipped; among them, 9 patients were cured with a favorable outcome, and 1 patient recovered but with slight disability. Among the other 12 cases with tear or avulsion of the BBA after clipping, the aneurysm and its parent artery had to be trapped in 9 cases. Complications in these 12 cases 3-14 days after surgery had led to ICA system occlusion on the BBA side, resulting in patient death in 9 cases, severe disability in 1 patient, persistent vegetative state in 1 patient, and 1 patient died 4 days later after bypass resurgery.

Conclusions: Preoperative diagnosis of BBAs is essential for proper management. Once the BBA has ruptured, the emergency clipping operation should be performed with caution. Moreover, based on lessons learned from direct clipping and a literature review, interventional therapy appears to be a more physiologic and more definitive treatment option for BBAs of the ICA, with a more favorable patient outcome.

Keywords: Aneurysm clipping; Blister-like aneurysm; Internal carotid artery; Neurosurgical management.