title: Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery.
abstract: OBJECTIVE
  Ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods.
  
  
  METHODS
  Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42-57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated.
  
  
  RESULTS
  All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4-26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography.
  
  
  CONCLUSIONS
  In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.
authors.affiliation: Departments of Radiology, Eulji University Hospital, Daejeon, Seoul, Republic of Korea.
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Lee
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
authors.forename: Moon Sun
authors.initials: MS
authors.lastname: Park
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Park
authors.forename: Eun Chul
authors.initials: EC
authors.lastname: Chung
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Suh
authors.forename: Chun Sik
authors.initials: CS
authors.lastname: Choi
authors.forename: Yu Sam
authors.initials: YS
authors.lastname: Won
authors.forename: In Kyu
authors.initials: IK
authors.lastname: Yu
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents