A ruptured blood blister like aneurysm in internal carotid artery communicating segment: An illustrated case

Blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare, fragile lesions associated with high bleeding and present technical challenges in management. BBAs of the ICA communicating segment are particularly uncommon and complex because they require preservation of critical branches, including the posterior communicating and anterior choroidal arteries. We report a case of a 34-year-old man with a subarachnoid hemorrhage from a ruptured BBA of the right ICA communicating segment, successfully treated with stent-assisted coiling (SAC). Four hours post-administration of loading doses of prasugrel (20 mg) and aspirin (200 mg), early endovascular treatment with SAC using an LVIS stent and helical coils achieved complete aneurysm obliteration without perioperative complications. Follow-up imaging demonstrated durable occlusion, and the patient was discharged with an excellent neurological outcome. This case demonstrates that SAC, following dual antiplatelet loading, is a feasible and effective reconstructive strategy for ruptured BBAs of the ICA communicating segment.