ABSTRACT
Objective To investigate the therapeutic effect of choosing reasonable treatment modality for ruptured blood blister-like aneurysms (B B A) of the supraclinoid internal carotid artery. Methods From September 2016 to September 2018, six patients with ruptured BBA of the supraclinoid internal carotid artery admitted to the Department of Neurosurgery of Sanbo Brain Hospital, Capital Medical University were consecutively and retrospectively recruited. DSA were performed to confirm the aneurysms and head CT showed subarachnoid hemorrhage in all patients. There were 3 cases in Hunt-Hess Crade I, 1 case in Grade H,1 case in Grade DI and 1 case in Grade IV. Endovascular treatments were performed in Hunt-Hess grade I - HI patients by double overlapping stents or covered stent according to the characteristics of cerebral angiography. Simultaneous coil embolization was applied in the acute stage of subarachnoid hemorrhage. Microsurgical suture for aneurysms was performed in Hunt-Hess grade IV patients. All patients were followed up by DSA,MR angiography (M R A) or CT angiography (CTA) 6months after operation. A modified Rankin Scale (mRS) was used for postoperative recovery measurement of neurological function (good outcome, mRS 0 -2; bad outcome, mRS 3 -6; and death, mRS 6). Results Among the 6 patients,5 underwent endovascular treatment and 1 underwent microsurgical treatment. Immediate postoperative angiography showed 3 cases of Raymond grade I , 1 case of Raymond grade II and 1 case of Raymond grade IH. No intraoperative rupture of the aneurysms occurred. After the operation, the limb muscle strength was grade V and there was no neurological dysfunction. Cranioplasty was performed 3 months after the operation. The mean follow-up time was 13.6months (range3 to 27 months). MRS score was 0 in4cases, 1 in 1 case and 2 in 1 case. All patients recovered well without recurrence. The parent artery was mild stenosis(stenosis rate was about 20%) in surgical patients. Conclusions For ruptured blood blister-like aneurysms(B B A) of the supraclinoid internal carotid artery, endovascular treatment is preferred in Hunt-Hess grade I - M patients by double overlapping stents or covered stent according to angiographic features, and simultaneous dense coil embolization can be performed in the acute stage of hemorrhage; Microsurgery may be the first choice in higher Hunt-Hess grade. Choosing appropriate treatment modality could achieve satisfactory therapeutic effect.