title: Successful treatment of a blood blister-like aneurysm of the internal carotid artery by trapping with a high-flow bypass.
abstract: Treatment of blood blister-like aneurysms of the internal carotid artery (ICA) is difficult because the wall of the aneurysm is fragile and there is a high risk of rebleeding. There has been no consensus on the best way to treat these aneurysms. A 32-year-old woman presented with subarachnoid hemorrhage (SAH) caused by a ruptured blood blister-like aneurysm of the ICA. The site of the aneursym was clipped. Although angiography 1week after the operation showed that the aneurysm had been treated successfully, 3 weeks after the initial operation, the aneurysm was found to have recurred to the distal side. In a second operation, the aneurysm was successfully treated by trapping with a high-flow bypass. This case shows that clipping of the rupture site can be insufficient to treat blood blister-like aneurysm of the ICA causing SAH, even if the aneurysm seems to have resolved in follow-up angiographic studies. Trapping of the ICA with a bypass, if necessary a high-flow bypass, is recommended.
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Akitsugu
authors.initials: A
authors.lastname: Kawashima
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawamata
authors.forename: Hideaki
authors.initials: H
authors.lastname: Onda
authors.forename: Osami
authors.initials: O
authors.lastname: Kubo
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Hori
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020215:Carotid Artery, Internal, Dissection / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D002941:Circle of Willis / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D013525:Surgical Instruments; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*