Blood Blister‑like Aneurysm of the Internal Carotid Artery – a Case Report and Review of Literature

Česká verzia

Authors: J. Mraček ¹; V. Runt ¹; P. Duras ²; V. Přibáň ¹
Authors place of work: LF UK a FN Plzeň Neurochirurgické oddělení ¹; LF UK a FN Plzeň Klinika zobrazovacích metod ²
Published in the journal: Cesk Slov Neurol N 2014; 77/110(3): 373-379
Category: Case Report

Podpořeno MZ ČR – RVO (Fakultní nemocnice Plzeň – FNPl, 00669806).

Summary

Blood blister-like aneurysm is a rare but clinically very important cause of subarachnoid hemorrhage. Since this is a false aneurysm with a very thin and fragile wall, its treatment is associated with high morbidity and mortality. Blood blister-like aneurysms are a diagnostic and therapeutic challenge. We describe a case of ruptured blister aneurysm of the internal carotid artery, initially treated by clipping. Early postoperative re-rupture was treated with microsuturing of the tear of the carotid artery. Late malignant ischemia subsequently developed, in spite of successful reconstruction of the parent artery. The authors review current strategies in the treatment of blood blister-like aneurysms.

Key words:
aneurysm – internal carotid artery – subarachnoid hemorrhage – endovascular treatment

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Abe M, Tabuchi K, Yokoyama H, Uchino A. Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 1998; 89(3): 419– 424.

2. Ogawa A, Suzuki M, Ogasawara K. Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery 2000; 47(3): 578– 583.

3. Mitha AP, Spetzler RF. Blister‑like aneurysms: an enigma of cerebrovascular surgery. World Neurosurg 2010; 74(4– 5): 444– 445. doi: 10.1016/ j.wneu.2010.10.006

4. Sundt TM jr, Murphey F. Clip‑ grafts for aneurysm and small vessel surgery. 3. clinical experience in intracranial internal carotid artery aneurysms. J Neurosurg 1969; 31(1): 59– 71.

5. Horiuchi T, Kusano Y, Yako T, Murata T, Kakizawa Y, Hongo K. Ruptured anterior paraclinoid aneurysms. Neurosurg Rev 2011; 34(1): 49– 55. doi: 10.1007/ s10143– 010– 0272– 7.

6. Nakagawa F, Kobayashi S, Takemae T, Sugita K. Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 1986; 65(3): 303– 308.

7. Ishikawa T, Nakamura N, Houkin K, Nomura M. Pathological consideration of a „blister‑like“ aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery 1997; 40(2): 403– 405.

8. Shigeta H, Kyoshima K, Nakagawa F, Kobayashi S. Dorsal internal carotid artery aneurysms with special reference to angiographic presentation and surgical management. Acta Neurochir (Wien) 1992; 119(1– 4): 42– 48.

9. McLaughlin N, Laroche M, Bojanowski MW. Surgical management of blood blister‑like aneurysms of the internal carotid artery. World Neurosurg 2010; 74(4– 5):483– 493. doi: 10.1016/ j.wneu.2010.06.039.

10. Vishteh AG, Spetzler RF. Blister or berry aneurysm. J Neurosurg 1999; 91(6): 1062– 1063.

11. Gaughen JR jr, Raghavan P, Jensen ME, Hasan D,Pfeffer AN, Evans AJ. Utility of CT angiography in the identification and characterization of supraclinoid internal carotid artery blister aneurysms. AJNR Am J Neuroradiol 2010; 31(4): 640– 644. doi: 10.3174/ ajnr.A1893.

12. Garrett M, Spetzler RF. Surgical treatment of blister‑like aneurysms. World Neurosurg 2012; 77(1): 76– 77. doi: 10.1016/ j.wneu.2011.07.041.

13. Kazumata K, Nakayama N, Nakamura T, Kamiyama H, Terasaka S, Houkin K. Changing treatment strategy from clipping to radial artery graft bypass and parent artery sacrifice in patients with ruptured blister‑like internal carotid artery aneurysms. Neurosurgery 2014; 10 (Suppl 1): 66– 73. doi: 10.1227/ NEU.0000000000000076.

14. Yanaka K, Meguro K, Nose T. Repair of a tear at the base of a blister‑like aneurysm with suturing and an encircling clip: technical note. Neurosurgery 2002; 50(1): 218– 221.

15. Lee JW, Choi HG, Jung JY, Huh SK, Lee KC. Surgical strategies for ruptured blister‑like aneurysms arising from the internal carotid artery: a clinical analysis of 18 consecutive patients. Acta Neurochir (Wien) 2009; 151(2): 125– 130. doi: 10.1007/ s00701– 008– 0165– 5.

16. Joo SP, Kim TS, Moon KS, Kwak HJ, Lee JK, Kim JH et al. Arterial suturing followed by clip reinforcement with circumferential wrapping for blister‑like aneurysms of the internal carotid artery. Surg Neurol 2006; 66(4): 424– 428.

17. Okuchi K, Fujioka M, Maeda Y, Nonaka M, Sakaki T.Surgical treatment of internal carotid artery anterior wall aneurysm with extravasation during angiography – case report. Neurol Med Chir (Tokyo) 1999; 39(1): 40– 44.

18. Yanaka K, Meguro K, Nose T. Repair of a tear at the base of a blister‑like aneurysm with suturing and an encircling clip: technical note. Neurosurgery 2002; 50(1): 218– 221.

19. Park PJ, Meyer FB. The Sundt clip graft. Neurosurgery 2010; 66 (6 Suppl Operative): 300– 305. doi: 10.1227/ 01.NEU.0000369923.05148.67.

20. Yanagisawa T, Mizoi K, Sugawara T, Suzuki A, Ohta T, Higashiyama N et al. Direct repair of a blister-like aneurysm on the internal carotid artery with vascular closure staple clips. Technical note. J Neurosurg 2004; 100(1): 146– 149.

21. Meling TR, Sorteberg A, Bakke SJ, Slettebø H, Hernesniemi J, Sorteberg W. Blood blister‑like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg 2008; 108(4): 662– 671. doi: 10.3171/ JNS/ 2008/ 108/ 4/ 0662.

22. Ishikawa T, Mutoh T, Nakayama N, Yasuda H, Nomura M, Kazumata K et al. Universal external carotid artery to proximal middle cerebral artery bypass with interposed radial artery graft prior to approaching ruptured blood blister‑like aneurysm of the internal carotid artery. Neurol Med Chir (Tokyo) 2009; 49(11): 553– 558.

23. Kawashima A, Okada Y, Kawamata T, Onda H,Kubo O, Hori T. Successful treatment of a blood blister‑like aneurysm of the internal carotid artery by trapping with a high‑flow bypass. J Clin Neurosci 2008; 15(7): 797– 800. doi: 10.1016/ j.jocn.2007.03.012.

24. Kamijo K, Matsui T. Acute extracranial‑ intracranial bypass using a radial artery graft along with trapping of a ruptured blood blister‑like aneurysm of the internal carotid artery. Clinical article. J Neurosurg 2010; 113(4): 781– 785. doi: 10.3171/ 2009.10.JNS09970.

25. Matsubara N, Miyachi S, Tsukamoto N, Izumi T, Naito T, Haraguchi K et al. Endovascular coil embolization for saccular‑ shaped blood blister‑like aneurysms of the internal carotid artery. Acta Neurochir (Wien) 2011; 153(2): 287– 294. doi: 10.1007/ s00701– 010– 0898– 9.

26. Doorenbosch X, Harding M. Primary treatment of a blood‑ blister‑like aneurysm of the internal carotid artery with Guglielmi detachable coil embolisation. J Clin Neurosci 2008; 15(11): 1276– 1279. doi: 10.1016/ j.jocn.2007.08.023.

27. Gaughen JR jr, Hasan D, Dumont AS, Jensen ME, McKenzie J, Evans AJ. The efficacy of endovascular stenting in the treatment of supraclinoid internal carotid artery blister aneurysms using a stent‑ in‑stent technique. AJNR Am J Neuroradiol 2010; 31(6): 1132– 1138. doi: 10.3174/ ajnr.A2016.

28. Kim BM, Chung EC, Park SI, Choi CS, Won YS. Treatment of blood blister‑like aneurysm of the internal carotid artery with stent‑ assisted coil embolization followed by stent‑ within‑a‑ stent technique. Case report. J Neurosurg 2007; 107(6): 1211– 1213.

29. Chung J, Kim BM, Lim YC. Five overlapping enterprise stents in the internal carotid artery‑ to‑ middle cerebral artery to treat a ruptured blood blister‑like aneurysm. Neurol Sci 2013; 34(8): 1485– 1487. doi: 10.1007/ s10072– 012– 1231– 6.

30. Martin AR, Cruz JP, Matouk CC, Spears J, Marotta TR.The pipeline flow‑ diverting stent for exclusion of ruptured intracranial aneurysms with difficult morphologies. Neurosurgery 2012; 70 (1 Suppl Operative): 21– 28. doi: 10.1227/ NEU.0b013e3182315ee3.

31. Causin F, Pascarella R, Pavesi G, Marasco R, Zambon G, Battaglia R et al. Acute endovascular treatment (< 48 hours) of uncoilable ruptured aneurysms at non‑branching sites using silk flow‑ diverting devices. Interv Neuroradiol 2011; 17(3): 357– 364.

32. Lee BH, Kim BM, Park MS, Park SI, Chung EC, Suh SH et al. Reconstructive endovascular treatment of ruptured blood blister‑like aneurysms of the internal carotid artery. J Neurosurg 2009; 110(3): 431– 436. doi: 10.3171/ 2008.7.JNS08257.