Abstract
Introduction: Blood blister-like (BBAs) aneurysms are rare cerebrovascular lesions for which the endovascular treatment methods are reviewed here. The reported pathogenesis varies, and hemodynamic stress, arterial dissection, and arteriosclerotic ulceration have all been described. The excessive fragility of BBAs and their parent vessels, can make microsurgical clipping technically difficult. Surgical treatment is associated with high rates of complications, morbidity, and mortality. The approach to the treatment of BBAs in recent times has shifted from microsurgical treatment to endovascular treatment, thanks to ongoing innovations in regard to endovascular techniques and devices. Method: The authors performed a review of available endovascular techniques used for blood blister-like aneurysms treatment. The Pubmed database was used as source search introducing “blood blister-like aneurysm” and “blister aneurysms” as keywords. The most relevant articles and those that focused on endovascular treatment techniques were selected. Discussion: Endovascular interventional techniques have evolved as an effective treatment for intracranial aneurysms. Considerable interest has emerged regarding the use of endovascular approaches to treat BBAs. In some studies, endovascular treatment of BBAs was associated with high rates of complete occlusion and good mid- to long-term neurological outcomes. Various endovascular techniques have been applied to treat BBAs, such as coil embolization, stenting, stent-assisted coiling and flow-diverting stents. Conclusion: From the available endovascular techniques, flow-diverting stents appears to be the safest and most effective treatment modality, with a higher rate of complete occlusion of an aneurysm and a lower rate of retreatment. The development of novel flow-diverting stents with decreased thrombogenic properties, may represents a key step forward and increases the potential for flow diversion becoming the gold standard for endovascular treatment of BBAs.Keywords: Intracranial aneurysm; Aneurysm, ruptured; Carotid artery disease; Subarachnoid hemorrhage; Endovascular procedures
Highlights
IntroductionBlood blister-like aneurysms (BBAs) are small lesions, sometimes appearing as just a protrusion of the vessel wall and are usually associated with diffuse subarachnoid hemorrhage (SAH) (FIGURE 1) and a severe clinical condition[1,2]
Blood blister-like (BBAs) aneurysms are rare cerebrovascular lesions for which the endovascular treatment methods are reviewed here
The authors perform a review of available endovascular techniques used for blood blisterlike aneurysms treatment, the Pubmed database was used as source search introducing “blood blister-like aneurysm” and “blister aneurysms” as keywords
Summary
Blood blister-like aneurysms (BBAs) are small lesions, sometimes appearing as just a protrusion of the vessel wall and are usually associated with diffuse subarachnoid hemorrhage (SAH) (FIGURE 1) and a severe clinical condition[1,2]. They are not detected at the first angiography due to their small dimensions and unusual site, but because of their rapid growth they appear more evident a few days later and tend to re-rupture[1,3,7,8] They appear as wide-necked shallow outpouchings of non-branching sites commonly of the supraclinoid ICA[8] (FIGURE 2). It is necessary intraoperative observation for the final diagnosis, because the angiographic evidence of a saccular shape did not always correlate with the nature of the aneurysm wall[3,9].
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