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Endovascular Treatment of a “Blister-like” Aneurysm of the Internal Carotid Artery

Published online by Cambridge University Press:  02 December 2014

P.D. McNeely ,
D.B. Clarke ,
B. Baxter ,
R.A. Vandorpe  and
I. Mendez
P.D. McNeely
Affiliation:
Division of Neurosurgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova, Scotia, Canada
D.B. Clarke
Affiliation:
Division of Neurosurgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova, Scotia, Canada
B. Baxter
Affiliation:
Division of Neurosurgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova, Scotia, Canada
R.A. Vandorpe
Affiliation:
Division of Neurosurgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova, Scotia, Canada
I. Mendez
Affiliation:
Division of Neurosurgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova, Scotia, Canada
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Abstract

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Backgound:

“Blister-like” aneurysms of the supraclinoid internal carotid artery have recently been recognized as having unique pathological and clinical features. Little is known regarding their optimal treatment modality.

Methods:

We report a case of a “blister-like” aneurysm of the internal carotid artery treated with Guglielmi detachable coil (GDC) embolization. Case Report: A 55-year-old man presented with a Hunt & Hess grade II subarachnoid hemorrhage. Computed tomography revealed diffuse subarachnoid blood. Cerebral angiography demonstrated a broad-based bulge on the medial wall of the right distal internal carotid artery. The patient was taken to the operating room and underwent a right pterional craniotomy and wrapping of this unclippable aneurysm. On postoperative day 11, he developed signs of vasospasm, and repeat angiography showed remarkable growth of the aneurysm. The aneurysm was believed to be amenable to endovascular therapy and was treated by GDC embolization. The patient recovered well and remained neurologically intact on follow-up examinations. Repeat cerebral angiography was performed three and nine months following his initial presentation and revealed a significant aneurysm neck remnant. This neck remnant was treated by repeat GDC embolization 13 months following his subarachnoid hemorrhage.

Conclusion:

“Blister-like” aneurysms of the internal carotid artery are important to recognize and are difficult to manage using traditional surgical approaches. Early repeated cerebral angiography is indicated and, where appropriate, endovascular therapy should be considered in the management of these patients.

Résumé:

RÉSUMÉ:Introduction:

On reconnaîdepuis peu que les anéismes de la carotide interne ayant la forme d’une phlyctè ont des caractéstiques anatomopathologiques et cliniques uniques. On connaîpeu de choses en ce qui a trait au traitement optimal de ces anéismes.

Méodes:

Nous rapportons un cas d’anéisme de la carotide interne ayant la forme d’une phlyctè, traitéar embolisation d’une spire déchable de Guglielmi (SDG).

Histoire de cas:

Un homme â de 55 ans a consultéour une hérragie sous-arachnoïenne de Hunt & Hess de grade II. Une tomographie assistépar ordinateur a montrén saignement sousarachnoïen diffus. L’angiographie cébrale a réléne tuméction àase large sur la paroi méale de la partie distale de la carotide interne droite. Le patient a é conduit en salle d’opétion oùn a procé àne crâotomie ptéonal droite et àn enveloppement de cet anéisme impossible àlipper. Au jour 11 en postopétoire, il a déloppées signes de vasospasme et une seconde angiographie a montréne croissance importante de l’anéisme. On a estiméue cet anéisme éit traitable par thépie endovasculaire et on a procé àne embolisation d’une SDG. Le patient a bien répé, sans séelle neurologique. Des angiographies de contrôont é faites trois et neuf mois aprèl’examen initial et ont rélén collet anéismal réduel important. Ce collet réduel a é traitéar une seconde embolisation d’une SDG 13 mois aprèl’hérragie sous-arachnoïenne.

Conclusion:

Il est important de diagnostiquer les anéismes de la carotide interne ayant la forme d’une phlyctè. Ces anéismes sont difficiles àraiter par les approches chirurgicales traditionnelles. Il est indiquée réter précement l’angiographie cébrale et on doit considér le traitement endovasculaire chez ces patients lorsque c’est approprié

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue 3 , August 2000 , pp. 247 - 250
Copyright
Copyright © The Canadian Journal of Neurological 2000

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