The Necessity of New Designed Device for Ruptured Internal Carotid Artery Trunk Blood Blister-like Aneurysms

Objective:To review major complications in procedures for blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA). Methods:We reviewed retrospectively 1176 patients with aneurysmal subarachnoid hemorrhage at the Hallym Medical Center between January 2001 and January 2012. There were 31 ICA trunk aneurysms: of them, 22 were BBAs and 9 were saccular aneurysms including one giant aneurysm. The saccular aneurysms were excluded from this study. The 22 BBA patients underwent clipping (n=13), trapping (n=2), endovascular procedures (n=6), and wrapping (n=1) treatments. Results:The average Hunt Hess grade was 3.0 (from 2 to 4) and the Fisher grade was 3.2 in the BBA cases (from 2 to 4). Half of the BBA cases had a history of hypertension. Twelve (54.5%) of the BBAs had intraoperative rupturing. The mean GOS was 3.14 and the mortality rate was high, at 31.8%. Conclusions:We had very high mortality with direct clippings and endovascular procedure during early learning curve, which had higher regrowth of BBA. We agree that the cerebral blood flow and volume should be protected by endovascular procedures with stents or high-flow bypass because the collateral circulation is quite vulnerable to vasospasm, although ICA sacrifice may be tolerable with balloon test occlusion for the trapping of BBAs.