title: Aneurysmal embolization of a blisterlike aneurysm of the internal carotid artery: a case report and review of the literature.
abstract: BACKGROUND
  Little is known regarding the optimal management of a ruptured blisterlike aneurysm of the ICA. Because of the high risk for intraoperative bleeding, direct surgical treatments of these fragile lesions have generally been associated with a poor outcome. We herein report a very rare case of a ruptured blisterlike aneurysm that was successfully treated with coil embolization in the late period.
  
  
  METHODS
  The patient was 21 years old when he had a Hunt and Hess grade IV subarachnoid hemorrhage. At the time of the hemorrhage, 3D-CTA demonstrated a minimal aneurysmal enlargement located in the left C2 portion of the ICA. Because of his poor neurological condition and the risk for a premature rupture during early surgery, delayed surgery was thus scheduled. Cerebral angiography, 13 days later, revealed the shape and size of the aneurysm to have changed in form from a blisterlike aneurysm to a saccular-type one. Initially, we planned to treat the aneurysm by trapping with bypass surgery on the 15th day. However, we instead performed coil embolization on the 19th day because a thick thrombus was found to cover the aneurysm at the time of surgery on the 15th day.
  
  
  CONCLUSIONS
  This is the first report of a ruptured blisterlike aneurysm that was successfully treated with coil embolization in the late period of a subarachnoid hemorrhage after operative confirmation of thrombus formation around the aneurysm. Our findings suggest that coil embolization in the late period appears to be an effective option in the management of selective cases of ruptured blisterlike aneurysms.
authors.affiliation: Department of Neurosurgery, Sasebo City General Hospital, Sasebo City 857-8511, Japan. ezaki-nsu@umin.ac.jp
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Ezaki
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takahata
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kamada
authors.forename: Shiro
authors.initials: S
authors.lastname: Baba
authors.forename: Makio
authors.initials: M
authors.lastname: Kaminogo
mesh_terms: D000328:Adult; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D014057:Tomography, X-Ray Computed