Dorsal Internal Carotid Artery Aneurysm Treated by Coil Embolization. Case Report.

Abstract

A 50-year-old male presented with an extremely rare dorsal wall aneurysm of the internal carotid artery manifesting as intracerebral hemorrhage. Computed tomography demonstrated intracerebral hemorrhage on the frontal base. Magnetic resonance imaging clearly showed the hemorrhage was related to an aneurysm of the internal carotid artery. Cerebral angiography disclosed an elongated aneurysm of the dorsal wall of the internal carotid artery. The aneurysm was packed as fully as possible with Guglielmi detachable coils to achieve complete obliteration. The patient was discharged without neurological deficits. Dorsal internal carotid artery aneurysms have a high risk of premature rupture due to their unusual shape and position, adhesion to the brain tissue, and fragile neck. Direct clipping requires careful brain retraction, necessary exposure of the aneurysm, and gentle neck manipulation. Endovascular treatment is an alternative method for obliteration of the aneurysmal sac.

Blood Blister-like Aneurysm Treated with Coil Embolization without Stent Assistance

“…They are rare, comprising 0.9% ~ 6.5% of all intracranial aneurysms 5) . Various surgical and endovascular treatments have been suggested for the treatments of blood blister-like aneurysms, including direct clipping, wrapping, clipping with wrapping material, clipping with Sundt encircling graft clips, proximal occlusion of the ICA, and proximal endovascular occlusion of the ICA followed by surgical clipping of the ICA distal to the aneurysm 2,4,5) . But, despite of these diverse endeavors to treat, blister aneurysm is quite challenging for both surgical and endovascular treatments 3) .…”

“…Few pathologic examinations have been performed for blood blister-like aneurysms, and it has been reported as focal wall defects covered by a thin layer of fibrous tissue and adventitia and lack of usual collagenous layer 2,5) . This unique nature of aneurysm wall leads to a marked weakness and high risk of premature rupture during surgical and endovascular procedures 1,3) .…”

“…Furthermore, the size and morphology of the aneurysm changed rapidly in just 15 days. Blood blister-like aneurysm may show rapid progression in size and morphology in repeated angiography 2,4) . In our case, the initial conventional digital subtraction angiography and CT angiography did not show a definite vascular pathology including aneurysm.…”

Blister-like aneurysms of the supraclinoid internal carotid artery: Challenging endovascular treatment with stent-assisted coiling

“…[13][14][15][16] To our knowledge, no case of a blister-like aneurysm treated with a combination of stenting and detachable coils has been reported. [13][14][15][16] To our knowledge, no case of a blister-like aneurysm treated with a combination of stenting and detachable coils has been reported.…”

Successful Staged Treatment for Ruptured Blister-Like Dissecting Aneurysm of the Intracranial Internal Carotid Artery: Acute GDC Embolization for the Blister-Like Aneurysm Followed by Proximal Occlusion with Extracranial-Intracranial Bypass in the Chronic Stage

“…In fact, regrowth of the aneurysm was seen in our case. But the coiling can act as a temporary plug on the fragile aneurysm and prevent rerupture during the acute stage [7,8], and thereby allow proximal occlusion with or without an extracranial±intracranial bypass in the chronic stage after assessment of the tolerance of ICA occlusion by a balloon occlusion test. We believe the chronic radical surgery is much safer than acute radical surgery for this disease in terms of postoperative ischemic complications and procedure-associated rerupture.…”