Treatment of two blood blister-like aneurysms with flow diverter stenting

Neurosurgical and endovascular treatment of fragile and recurrent aneurysms of the non-branching portion of the internal carotid artery, known as blister-like aneurysms, is challenging. The aim of this paper is to describe two cases of ruptured blister-like aneurysms of the internal carotid artery and of the vertebral artery at the origin of the postero-inferior cerebellar artery, which were both treated with flow diverter (FD) stents.

Two patients with a sub-arachnoid hemorrhage secondary to the rupture of a blister-like aneurysm were treated with a Pipeline (ev3, Irvine, California, USA) stent. Digital subtraction angiography and clinical follow-up were carried out.

Both patients treated with FD stents had an excellent clinical (modified Rankin Scale, mRS 0) and angiographic outcome. In both cases the aneurysms were completely excluded after 6 months.

Although the use of this endovascular approach is still debated because of poor experience and pharmacological limitations, FD stents may represent a valid alternative approach for treatment of this aneurysm subtype.