We report a case of ruptured blood blister-like aneurysm of internal carotid artery treated with wrap-clipping followed by endovascular coil embolization.
A 52-year-old woman suffered subarachnoid hemorrhage due to a ruptured blood blister-like aneurysm on the anteromedial wall of the right internal carotid artery (ICA). Since aneurysmal trapping following superficial temporal artery-middle cerebral artery anastomosis was abandoned because of disappearance of intraoperative motor evoked potential, wrap-clipping was performed finally to preserve the right ICA. The postoperative course was uneventful. Digital subtraction angiography (DSA) on the next day showed disappearance of the small bulge and mild stenosis of the right ICA at the site of wrap-clipping. Follow-up DSA 2 weeks after the operation showed reappearance of the aneurysm at the same portion of the right internal carotid artery. Endovascular coil embolization with ultrasoft GDCs was performed at 18 days after wrap-clipping of the aneurysm. The aneurysm disappeared after the procedure. Follow-up DSA after 1 year of coil embolization demonstrated complete obliteration of the aneurysm.
Endovascular coil embolization may be an alternative treatment for blood blister-like aneurysms in late-stage as long as the aneurysms are saccular in shape.