Kosin Med J.  2021 Dec;36(2):200-205. 10.7180/kmj.2021.36.2.200.

A Ruptured Blood Blister-Like Aneurysm that Experienced Regrowth with Coil Compaction Twice in a Month : Case Report

• Park JH

• KMID: 2524666
• DOI: http://doi.org/10.7180/kmj.2021.36.2.200

Abstract

Unlike other aneurysms, blood blister-like aneurysms(BBA) occur at non-branching sites, are commonly located at the dorsal wall of the supraclinoid internal carotid artery (ICA), and are suspected to arise from dissecting aneurysms. They are typically diagnosed after a bleed because of their small size and unusual site. Therefore, lesions exist after brain computed tomography or magnetic resonance imaging, but they are often not found. In the case of BBA, which have a high risk of recurrence, the treatment is difficult, and selecting the treatment method is also challenging. This paper describes the treatment of a BBA with internal trapping of the ICA that eventually recurred despite performing coil embolization twice.

Keyword

Blister; Blister; False aneurysm; False aneurysm; Endovascular procedures; Endovascular procedures

Figure

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  Fig. 1 Brain computed tomography(CT) scans show diffuse and thick subarachnoid hemorrhage in the basal cistern and both sylvian fissure (A). Contrast-enhanced CT angiography shows a cerebral aneurysm in the right distal ICA(white circle) (B).

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  Fig. 2 In the 4-vesselangiography, a ruptured cerebral aneurysm of a saccular type is observed on the dorsal wall of distal Internal cerebral artery(ICA)(white arrow)(A). The stent was deployed from the proximal ICA to the proximal middle cerebral artery, and the microcatheter was placed in the sac of aneurysm, and then coiling was performed (B). Endovascular coiling was densely packed into the aneurysm sac, and the procedure was terminated after confirming that there was no contrast filling with an aneurysm sac anymore

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  Fig. 3 The regrowth and coil compaction of aneurysm were observed in 4-vesselangiography two weeks after the first coil embolization (A). It was determined that additional treatment was necessary, endovascular coiling was performed on the recurrent aneurysm sac, and the procedure was terminated after checking the complete occlusion of the sac (B).

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  Fig. 4 The regrowth of cerebral aneurysm is observed again in 4-vesselangiography, which was performed two weeks after the additional procedure (A). Internal trapping treatment of distal internal cerebral artery was performed using coils (B). In the 4-vessel angiography conducted by the opposite internal cerebral artery, the flow of blood toward the lesion could be confirmed through anterior communicating artery (C).

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  Fig. 5 After the second procedure, low density near the right motor cortex is observed and is thought to be a suspected cerebral infarction (white arrow).

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