Endovascular Treatment of Ruptured Blood Blister-like Aneurysms Using the LVIS EVO Stents

Abstract

Blood blister-like aneurysms (BBAs) are rare cerebrovascular lesions that face serious challenges in surgical as well as endovascular treatment. In this paper, we present our experience in treating BBAs using the LVIS EVO stents. A total of 10 patients (mean age of 56.1 years) with 13 BBAs, who were admitted to our university hospital between April 2020 and November 2021 with a subarachnoid hemorrhage (SAH) due to aneurysm rupture, were treated using the LVIS EVO stents. Treatment of the BBAs consisted of stent-assisted coiling in four patients and stenting in six patients. The aneurysms were located within ICA (84.6%), VA (7.7%), and MCA (7.7%). Placement of the LVIS EVO stents was successful in all patients. No technical complications were observed. One in-stent thrombotic event occurred during the procedure. MRA for one-year follow-up was performed in nine patients. One patient died (Hunt and Hess Grade IV). LVIS EVO stents may be a beneficial treatment option for BBAs, as they provide high occlusion rates. However, the long-term efficacy remains uncertain.

Keywords: blood blister-like aneurysm; embolization; endovascular treatment.

Figure 1

Pretreatment right vertebral lateral angiography (A) shows the blood blister-like aneurysm (arrow) below posterior inferior cerebellar artery (PICA). Postembolization angiography (B) reveals reduced filling of the aneurysm’s sac. Excellent apposition to the vessel wall and compacting the mesh around the aneurysm’s neck are visualized on intraprocedural contrast-enhanced flat panel detector CT (MIP reconstruction) (C). One year following the treatment, MRI revealed good positioning of the stent (arrow) and complete occlusion of the aneurysm (D).

Figure 2

An oblique view of a left carotid artery angiogram revealed a tiny aneurysmal bulge in the supraclinoid segment of ICA (A), treated with the stent only and the post-procedural angiogram demonstrated filling the aneurysm (B). Fluoroscopic view during the stent positioning and implantation (C), and post stent deployment with the microcatheter markers in the parent vessel (D). Coronal (E) and axial (F) views of the 1-year MR TOF follow-up shows full occlusion of the treated aneurysm and good visualization of stent wall (arrows).