The Clinical Management Experience In Treating Special, Ruptured, Blood Blister-Like Aneurysms: A Case Report And Literature Review

Blood blister-like aneurysms (BBAs) are a rare type of ruptured intracranial aneurysm accounting for 0.5-2.0% of all aneurysms and are fragile and arise from non-branching vessels. BBAs remain the most difficult cerebrovascular lesions to diagnose and treat, especially BBAs combined with other intracranial aneurysms. The management of BBAs is a huge challenge for neurointerventionalists and neurosurgeons because their diagnosis and treatment are difficult. There are high morbidity and mortality rates in surgical clipping and a high complication rate in endovascular embolization. We report a special case who presented with a sudden headache and vomiting for two hours. Acute subarachnoid hemorrhage (SAH) was diagnosed after a computerized tomography (CT) scan, and the severity and distribution of the SAH and hematoma were similar on both sides. Only a left carotid-ophthalmic aneurysm was found on the first digital subtraction angiography (DSA) and CTA scan. The second DSA confirmed a right carotid BBA (ruptured) after one week. The patient successfully underwent a double stent-assisted coil embolization without ischemia or neurological dysfunction. Additionally, the aneurysm was completely occluded after a re-examination. Based on the literature review, the diagnosis of BBAs is difficult due to their tiny size, especially when combined with other intracranial aneurysms. The double stent-assisted coil embolization technique might be a good choice for BBAs, especially those not suitable for clipping or embolization.