title: Surgical treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery with extracranial-intracranial bypass and trapping.
abstract: OBJECTIVE
  Blood blister-like aneurysms (BBAs) arise from the supraclinoid internal carotid artery (ICA) at non-branching sites. These aneurysms are challenging to treat primarily with either surgical clip placement or endovascular therapy. The authors describe a series of 4 patients who presented with high-grade subarachnoid hemorrhage (SAH) due to a BBA, which was treated with an extracranial-intracranial (EC-IC) bypass followed by trapping of the aneurysm.
  
  
  METHODS
  Four patients presented with SAH due to a BBA of the ICA. Three of these patients were treated with an endovascular procedure; following the vasospasm period, definitive treatment with EC-IC bypass followed by trapping of the aneurysmal parent vessel was performed.
  
  
  RESULTS
  Two of the patients who were treated endovascularly suffered rebleeding prior to bypass and trapping. Three of the 4 patients had a good outcome (modified Rankin Scale Score 1 or 2), and 1 patient who suffered 2 episodes of rebleeding died.
  
  
  CONCLUSIONS
  Treatment of BBAs of the ICA remains difficult, particularly in the setting of high-grade SAH. Patients with this challenging condition often require multiple procedures and have a high incidence of rebleeding. Definitive treatment of these aneurysms consists of EC-IC bypass and surgical or endovascular trapping.
authors.affiliation: Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA. m.baskaya@neurosurg.wisc.edu
authors.forename: Mustafa K
authors.initials: MK
authors.lastname: Başkaya
authors.forename: Azam S
authors.initials: AS
authors.lastname: Ahmed
authors.forename: Ozkan
authors.initials: O
authors.lastname: Ateş
authors.forename: David
authors.initials: D
authors.lastname: Niemann
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery