Report of the Outcome of 6-year Blood Blister-Like Aneurysm Treatment Using Clipping Technique: A Single-Center Experience

Abstract

Background and Objectives

Blood blister-like aneurysms (BBA) are rare vascular lesions with challenging treatment. While direct surgery has been the primary technique for treating BBA, there has been a shift toward endovascular methods in recent years. This article presents a retrospective case series of patients treated with direct surgery at our center over a 6-year period.

Methods

Patients who underwent surgery for BBA from 2014 to 2019 were evaluated. Data on surgical procedures, complications, and clinical outcomes were obtained from patients' medical records. Additionally, patients were contacted to provide updates on their treatment outcomes.

Results

A total of 17 patients were treated for BBA during the study period. All cases presented with subarachnoid hemorrhage and were treated using the clipping method. Intraoperative rupture occurred in 11 patients. Additionally, internal carotid artery sacrificing was done in five patients due to avulsion during surgery. Of these 17 patients, 11 (64.7%) had favorable outcomes following surgery, while the mortality rate was 29.4% (5 patients).

Conclusion

The rate of favorable outcomes and mortality associated with the direct surgery technique at our center was comparable to results from other centers. Further studies are required to determine the optimal method for treating BBA.

Keywords

aneurysm - blood blister-like aneurysm - direct clipping - internal carotid artery - subarachnoid hemorrhage

Publication History

Received: 16 July 2024

Accepted: 27 March 2025

Accepted Manuscript online:
28 March 2025

Article published online:
26 June 2025

• References

• 1 Aboukais R, Tétard MC, Devalckeneer A. et al. Ruptured blood blister like aneurysm: does the best therapeutic option really exist?. Neurosurg Rev 2021; 44 (05) 2767-2775
• 2 Sanchez VE, Haider AS, Rowe SE. et al. Comparison of blister aneurysm treatment techniques: a systematic review and meta-analysis. World Neurosurg 2021; 154: e82-e101
• 3 Peschillo S, Cannizzaro D, Missori P. et al. Reconstructive endovascular treatment of a ruptured blood blister-like aneurysm of anterior communicating artery. J Neurosurg Sci 2017; 61 (04) 438-441
• 4 Gonzalez AM, Narata AP, Yilmaz H. et al. Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol 2014; 83 (01) 197-205
• 5 Rasskazoff S, Silvaggio J, Brouwer PA, Kaufmann A, Nistor A, Iancu D. Endovascular treatment of a ruptured blood blister-like aneurysm with a flow-diverting stent. Interv Neuroradiol 2010; 16 (03) 255-258
• 6 Jiang Y, Luo J, Zheng J, Li Y. Endovascular pure electrocoagulation of intracranial perforator blister-like aneurysm not accessible to microcatheter-new approach to treat small vessel hemorrhage disease. Int J Stroke 2016; 11 (05) NP60-NP61
• 7 Kawashima A, Okada Y, Kawamata T, Onda H, Kubo O, Hori T. Successful treatment of a blood blister-like aneurysm of the internal carotid artery by trapping with a high-flow bypass. J Clin Neurosci 2008; 15 (07) 797-800
• 8 McNeely PD, Clarke DB, Baxter B, Vandorpe RA, Mendez I. Endovascular treatment of a “blister-like” aneurysm of the internal carotid artery. Can J Neurol Sci 2000; 27 (03) 247-250
• 9 Nishi T, Kaji M, Koga K. et al. Clipping on crossed wrapping method for ruptured blood blister-like aneurysm of the internal carotid artery: technical note and long-term results. World Neurosurg X 2019; 2: 100005
• 10 Owen CM, Montemurro N, Lawton MT. Blister aneurysms of the internal carotid artery: microsurgical results and management strategy. Neurosurgery 2017; 80 (02) 235-247
• 11 Paiva ALC, Aguiar GB, Flores JAC, Veiga JCE. Slip clip after successful microsurgery of a blister aneurysm: should bypass always be the first option?. J Cerebrovasc Endovasc Neurosurg 2021; 23 (03) 245-250
• 12 Park JH, Park IS, Han DH. et al. Endovascular treatment of blood blister-like aneurysms of the internal carotid artery. J Neurosurg 2007; 106 (05) 812-819
• 13 Yu J, Xu B, Guo Y, Xu K. Direct clipping of a blister-like aneurysm in the supraclinoid segment of the internal carotid artery: a clinical analysis of nine cases. Int J Clin Exp Med 2015; 8 (11) 21786-21795
• 14 Szmuda T, Sloniewski P, Waszak PM, Springer J, Szmuda M. Towards a new treatment paradigm for ruptured blood blister-like aneurysms of the internal carotid artery? A rapid systematic review. J Neurointerv Surg 2016; 8 (05) 488-494
• 15 Park TJ, Kim KH, Cho JH. The blood blister like-aneurysm: usefulness of sundt clip. J Cerebrovasc Endovasc Neurosurg 2017; 19 (03) 171-183
• 16 Konczalla J, Gessler F, Bruder M, Berkefeld J, Marquardt G, Seifert V. Outcome after subarachnoid hemorrhage from blood blister-like aneurysm rupture depends on age and aneurysm morphology. World Neurosurg 2017; 105: 944-951.e1
• 17 Tan H, Zhang T, Huang G. et al. Endovascular intervention vs. microsurgery on the prognosis of anterior circulation blood blister-like aneurysm: a cohort study. Front Neurol 2023; 14: 1103138
• 18 Nasra M, Mitreski G, Kok HK. et al. Contemporary treatment of intracranial blood blister aneurysms - a systematic review. J Stroke Cerebrovasc Dis 2021; 30 (09) 105968
• 19 Egashira Y, Enomoto Y, Nakayama N. et al. Real-world treatment results for ruptured blood-blister aneurysm of the internal carotid artery: analysis of a Japanese nationwide multicenter study. Neurosurg Rev 2021; 44 (06) 3539-3546
• 20 Meling TR, Patet G. The role of EC-IC bypass in ICA blood blister aneurysms-a systematic review. Neurosurg Rev 2021; 44 (02) 905-914
• 21 Ghorbani M, Keykhosravi E, Vatanparast M. et al. Flow diverting stent monotherapy as the best choice in the treatment of intracranial blood blister-like aneurysms: a systematic review. Neurosurg Rev 2024; 47 (01) 513
• 22 Lee J, Kim DH, Lee SH. et al. Stent-assisted coiling vs. flow diverter for treating blood blister-like aneurysms: a proportion meta-analysis. Clin Neuroradiol 2022; 32 (04) 889-902
• 23 Balik V, Kourilova P, Sulla IJ. et al. Comparison of bypass and non-bypass surgical treatments for internal carotid artery blood blister-like aneurysms: a meta-analysis of efficacy, safety, and outcomes. World Neurosurg 2020; 144: 283-292.e12
• 24 Roy AK, Lekka E, Lee KH, Choi P, Day AL, Roc Chen P. Meta-analysis on the treatment options and outcomes of carotid blood blister aneurysms. J Clin Neurosci 2021; 92: 147-152
• 25 Zhai XD, Song BW, Xiang SS. et al. Wrap-clipping for patients with ruptured blood blister-like aneurysms of the internal carotid artery: case series and literature review. J Neurol Surg A Cent Eur Neurosurg 2022; 83 (04) 301-307
• 26 Jin D, Zhang Z, Su X, Li G. Comparative analysis of characteristics, management, and clinical outcome of blood blister-like aneurysms treated with flow diverter devices: a systematic review and meta-analysis of 30 studies. Int J Surg 2025; 111 (01) 1427-1439
• 27 Ghorbani M, Griessenauer CJ, Wipplinger C. et al. Flow diverter embolization device for endovascular treatment of ruptured blister and wide necked very small aneurysms. Heliyon 2019; 5 (09) e02241
• 28 Peschillo S, Cannizzaro D, Caporlingua A, Missori P. A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms. AJNR Am J Neuroradiol 2016; 37 (05) 856-861