Objective Blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are challenging to treat. We assessed the clinical and radiologic outcomes in patients with ruptured BBAs of the ICA treated with wrap-clipping.Methods From November 2016 to January 2020, the clinical and radiologic data of patients with subarachnoid hemorrhage (SAH) caused by ICA BBAs who underwent wrap-clipping were retrospectively analyzed. The clinical outcomes were evaluated according to the modified Rankin Scale (mRS). Radiologic follow-up examinations included digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA).Results Seven patients were enrolled in this study. All BBAs were wrap-clipped successfully, including two BBAs that exhibited intraoperative bleeding and required balloon-assistance during surgery. All patients had favorable clinical outcomes during follow-up. Among the six patients who completed the radiologic follow-up visit, one patient presented ICA occlusion at the 6-month DSA follow-up, but no neurologic dysfunction was noted. We did not observe the progression of ICA stenosis in other patients.Conclusion All BBAs in this study were wrap-clipped successfully and completely occluded. Wrap-clipping is effective for BBAs of the ICA and has favorable clinical outcomes. A multicenter study with a large sample size and a longer radiologic follow-up is necessary.

Objective Blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are challenging to treat. We assessed the clinical and radiologic outcomes in patients with ruptured BBAs of the ICA treated with wrap-clipping.Methods From November 2016 to January 2020, the clinical and radiologic data of patients with subarachnoid hemorrhage (SAH) caused by ICA BBAs who underwent wrap-clipping were retrospectively analyzed. The clinical outcomes were evaluated according to the modified Rankin Scale (mRS). Radiologic follow-up examinations included digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA).Results Seven patients were enrolled in this study. All BBAs were wrap-clipped successfully, including two BBAs that exhibited intraoperative bleeding and required balloon-assistance during surgery. All patients had favorable clinical outcomes during follow-up. Among the six patients who completed the radiologic follow-up visit, one patient presented ICA occlusion at the 6-month DSA follow-up, but no neurologic dysfunction was noted. We did not observe the progression of ICA stenosis in other patients.Conclusion All BBAs in this study were wrap-clipped successfully and completely occluded. Wrap-clipping is effective for BBAs of the ICA and has favorable clinical outcomes. A multicenter study with a large sample size and a longer radiologic follow-up is necessary.

Blood blister-like aneurysms (BBAs) are rare and usually appear at nonbranching sites in the supraclinoid portion of the internal carotid artery (ICA). Because it is difficult to obtain histological specimens of the aneurysm wall and because experimental models are challenging to establish, the pathogenesis of BBAs remains uncertain. In this paper, we reviewed the diagnostic, radiological, and pathophysiological characteristics of patients with BBAs. We also summarized the existing evidence and potential mechanisms related to the causes of BBAs. Current evidence indicates that atherosclerosis and dissection are the main prerequisites for the formation of BBAs. Hemodynamics may play a role in the process of BBA formation due to the unique vascular anatomy of the supraclinoid ICA. Further research on histopathology and hemodynamics is warranted in this field.

A 46-year-old male presented to our hospital suffering from right mastoid pulsatile tinnitus secondary to traffic trauma. Digital subtraction angiography was remarkable for a vertebro-vertebral arteriovenous fistula fed by the right vertebral artery at the C1 level. Dual platelet therapy was administrated before and after the operation, then a Willis covered stent was deployed at the orifice of the fistula. Post-operative angiography showed proper stent localization but some contrast agent leaking from the fistula. Angiography performed 6 months post-operatively demonstrated no leak from the fistula and the patency of the right vertebral artery. This case demonstrated that an intracranial covered stent could be used as an alternative, successful treatment for vertebro-vertebral arteriovenous fistula.

In this article, we describe our institutional experience with the treatment for recurrent middle cerebral artery (M1) aneurysms (MCA-AN) after coil embolization using superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery. A 24-year-old male patient was diagnosed with MCA-AN by digital subtraction angiography (DSA) in Beijing Tian Tan Hospital. He underwent stent-assisted coil embolization of the aneurysms in Cedars-Sinai Medical Center, U.S., but the MCA-AN recurred at 6 months after the surgery. He further received endovascular coiling treatment in Cedars-Sinai Medical Center, but the surgeons failed to successfully complete the operation. Subsequently, the patient was transferred to Beijing Xuanwu Hospital and underwent STA-MCA bypass surgery in May 2017. The patient was followed up for over 1 year and no recurrent MCA-AN was observed. The diagnosis and therapeutic procedures of this case suggest that STA-MCA bypass surgery is probably a good option for patients presenting with recurrent MCA-AN following coiling embolization.

In this article, we describe our institutional experience with the treatment for recurrent middle cerebral artery (M1) aneurysms (MCA-AN) after coil embolization using superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery. A 24-year-old male patient was diagnosed with MCA-AN by digital subtraction angiography (DSA) in Beijing Tian Tan Hospital. He underwent stent-assisted coil embolization of the aneurysms in Cedars-Sinai Medical Center, U.S., but the MCA-AN recurred at 6 months after the surgery. He further received endovascular coiling treatment in Cedars-Sinai Medical Center, but the surgeons failed to successfully complete the operation. Subsequently, the patient was transferred to Beijing Xuanwu Hospital and underwent STA-MCA bypass surgery in May 2017. The patient was followed up for over 1 year and no recurrent MCA-AN was observed. The diagnosis and therapeutic procedures of this case suggest that STA-MCA bypass surgery is probably a good option for patients presenting with recurrent MCA-AN following coiling embolization.