Treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery using pipeline and lattice flow diverters and coiling.

Background: Flow diverters (FDs) have shown the potential to treat blood blister-like aneurysms (BBAs) of the supraclinoid internal carotid artery (ICA). We report a series of cases treated by both deploying FDs and coiling. Methods: Based on the Bojanowski classification, the BBAs of the supraclinoid ICA were classified into types I-IV. Based on the approach used for endovascular treatment (EVT) of the BBAs, the EVTs were categorized into types 1-3. The modified Rankin scale (mRS) was used to assess the clinical follow-up outcome. Results: Thirteen patients with 13 BBAs of the supraclinoid ICA who were aged 22-66 (49.8 ± 13.5) years were included. There were 12 females and 1 male. All patients had experienced subarachnoid hemorrhage. According to the Bojanowski's et al. classification, a total of 2, 7, 3, and 1 BBAs were categorized as types I, II, III, and IV, respectively. Preoperative vasospasms were detected in 4 patients. EVT types 1, 2, and 3 were used to treat 4, 7, and 2 BBAs, respectively. After EVT, 2 patients with preoperative vasospasm experienced hemiparesis but later recovered. One patient with a preoperative vasospasm experienced multiple infarctions and died. One patient who discontinued antiplatelet therapy experienced multiple infarctions and suffered severe disability. ‌Twelve patients completed a post-EVT six-month follow-up, excluding the one with postoperative mortality.‌ The mRS scores were 0, 1, and 4 for 10, 1, and 1 patients, respectively. Eleven patients were subjected to angiographic follow-up. All BBAs were cured, and the supraclinoid ICAs were repaired. Conclusion: For patients with BBAs, deploying an FD and coiling can yield good outcomes. However, ischemic complications should not be overlooked.