Endovascular Treatment of a Ruptured Blood Blister-Like Aneurysm with a Flow-Diverting Stent

Abstract

<jats:p> Treatment of BBAs is currently challenging and remains difficult despite improvement of microsurgical technique and advancement in endovascular technologies. Therapeutic options are reconstructive and deconstructive open surgeries or endovascular procedures. However, there is a lack of consensus about optimal treatment. We report a case of 38-year old woman with subarachnoid hemorrhage due to a ruptured BBA successfully treated with placement of an endovascular flow-diverting stent. </jats:p>

Pipeline Embolization Device in Aneurysmal Subarachnoid Hemorrhage

“…The PED should be an alternative to stent-assisted coiling for those vertebral artery dissections that require vessel preservation or for dissecting aneurysms in other vessels. This series, similar to other reports, 2,5,37 shows good results for blister aneurysms. Other surgical and endovascular approaches have been reported with mixed results.…”

“…34,35 The PED has been reported as a treatment alternative in acutely ruptured dissecting and blister aneurysms with good results, though the number of cases continues to be small. [2][3][4][5][6][7][8] The aneurysm occlusion is not immediate compared with coiling and surgical clipping; still, no rehemorrhages have been reported to date. Although there are minimal immediate angiographic changes, the PED may provide some immediate protection by reducing the aneurysm inflow, 36 with reconstruction of the parent vessel in the long term (Fig 1).…”

Flow Diversion for Intracranial Aneurysms

“…[35][36][37][38][39][40][41][42][43] Only 5 studies were prospective, 26,30 -33 and 4 of them included patients enrolled in multicenter studies/registries. 26,30,32,33 Table 1 summarizes the results of the 5 prospective studies.…”

The Management of Very Small/Blister Internal Carotid Artery Aneurysms

“…They feel that their results are as good as those of Parks et al without having to sacrifice the vessel 7 . Taking it a step further, Rasskazoff et al presented their BBA which they also treated with a stent within a stent procedure but in their case they used flow-diverters (Silk stents) with a good result in the patient they treated 15 . As stated above, the use of stents is not without problems especially when a patient with an acute SAH needs to be put on double antiplatelet treatment before the stents are placed.…”