Abstract
Cerebral blister aneurysms are very difficult vascular lesions in terms of accurate
diagnosis as well as proper management strategy for vascular neurosurgeons and neurointerventionists.
Histopathological analysis has revealed their nature to be more akin to pseudoaneurysms
in comparison to the typical berry aneurysms. This explains their fragile nature,
with high probability of rerupture and regrowth during the follow-up if not addressed
properly. Even though surgical approaches have evolved over the years to minimize
intraprocedural rupture and recurrence, they still have relatively high morbidity
as well as mortality in comparison to endovascular treatment. Over the last few years,
endovascular treatment has evolved significantly, with introduction of new devices
and techniques. Focus of the endovascular management has shifted from the deconstructive
techniques to reconstructive ones with parent artery preservation. Recent introduction
of flow diverter technology has enabled neurointerventionists to manage these difficult
lesions with more confidence in terms of avoiding rerupture and recurrence. Flow diverter
(FD) use in blister aneurysm resulted in high-technical success, complete aneurysm
occlusion, and less complications in comparison to other reconstructive techniques
like simple coiling, stent assisted coiling, and overlapping/monotherapy stent placement.
Few debatable issues like use of dual antiplatelets in the setting of acute subarachnoid
hemorrhage (SAH), timing of drugs in relation to procedures, single/overlapping devices,
and concerns during cerebral vasospasm phase need further detailed analysis and standardized
protocols. In this article, we have done a review of different endovascular treatment
options in the management of internal carotid artery blister aneurysms with special
focus on FD and issues related to it.
Keywords
blister aneurysms - endovascular management - flow diverter
