Endovascular treatment of a "blisterlike" aneurysm of the internal carotidartery

Background: "Blister-like" aneurysms of the supraclinoid internal carotid a rtery have recently been recognized as having unique pathological and clini cal features. Little is known regarding their optimal treatment modality. M ethods: We report a case of a "blister-like" aneurysm of the internal carot id artery treated with Guglielmi detachable coil (GDC) embolization. Case R eport: A 55-year-old man presented with a Hunt & Hess grade II subarachnoid hemorrhage, Computed tomography revealed diffuse subarachnoid blood. Cereb ral angiography demonstrated a broad-based bulge on the medial wall of the right distal internal carotid artery. The patient was taken to the operatin g room and underwent a right pterional craniotomy and wrapping of this uncl ippable aneurysm. On post operative day 11, he developed signs of vasospasm , and repeat angiography showed remarkable growth of the aneurysm. The aneu rysm was believed to be amenable to endovascular therapy and was treated by GDC embolization. The patient recovered well and remained neurologically i ntact on follow-up examinations, Repeat cerebral angiography was performed three and nine months following his initial presentation and revealed a sig nificant aneurysm neck remnant. This neck remnant was treated by repeat GDC embolization 13 months following his subarachnoid hemorrhage, Conclusions: "Blister-like" aneurysms of the internal carotid artery are important to r ecognize and are difficult to manage using traditional surgical approaches. Early repeated cerebral angiography is indicated and, where appropriate, e ndovascular therapy should be considered in the management of these patient s.