Introduction: We would like to to review major complications by the procedure of blood blister-like aneurysms (BBAs) of the internal carotid artery.
Methods: We retrospectively reviewed 1176 patients with aneurysmal subarachnoid hemorrhage at the Hallym Medical Center between January 2001 and January 20012. There were 31 ICA trunk aneurysms, of which 22 were BBAs and 9 were saccular aneurysms including 1 giant aneurysm. Saccular aneurysms were excluded on this study. 22 BBA patients received treatments; clipping(13), trapping(2), endovascular procedures(6) and wrapping(1) were undertaken. Among 3 neurosurgeons of the three hospitals, one neurosurgeon(A) did 12 surgeries, another(B) did 3 clippings and 3 endovascular procedures, another(C) did 3 endovascular and 1clipping procedures.
Results: According to the location and size, there were 17 dorsal locations (mean size : 5.2mm, mean distance to cardinal branch : 4.2mm) and 5 ventral types (mean size : 5.8mm, mean distance to cardinal branch : 3.8mm). The average of the Hunt–Hess grade (H–H. G.) 3.0 and the Fischer grade (F. G.) were 3.2 respectively in the BBA cases. Half of BBAs had a history of hypertension. Twelve(54.5%) of the BBAs had intraoperative rupturing. One major lobar infarction was developed by vasospasm after the surgical trapping. Two hemiparesis cases were resulted by obliterations at the anterior choroidal arteries by Sundt clips. Two of the 5 patients who received the simple GDCs died of ICA rupture during the procedure or regrowth- rupture of ICA. 1 balloon assisted coil and 2 stent-coils-stent(SCS) had 5 GOS. The mean GOS was 3.14 and mortality rate was very high as 31.8%.
Conclusions: Actually, those mightr be clippable for the small dorsal BBAs which were distant to far form cardinal branches without major complications. If it is not a direct clippable BBA we should protect the cerebral blood flow and volume by the endovascular procedures or high flow bypass because the collateral circulation is quite vulnerable by vasospasm, although ICA sacrifice is tolerable by BTO for the trapping of BBAs.
Patient Care: We need data more about BBA.
Learning Objectives: Identify an effective treatment of blood blister-like aneurysm on the internal carotid artery