Selection Of Treatment Option And Prognostic Factors For Blood Blister-like Aneurysms

Objective:To explore the treatment of internal carotid artery blood blister-like aneurysms(BBAs),and to provide a basis for clinical diagnosis and treatment of internal carotid artery blood blister like aneurysms.Methods:A retrospective analysis was made of 21 cases of internal carotid artery blood blister-like aneurysms treated by microsurgery and interventional therapy.Among them,8 cases were treated by microsurgery,including simple clipping,combined clipping and wrapping and internal carotid artery isolation.13 cases were treated by stent-assisted aneurysm embolization,Willis covered stent and blood flow guiding device.Results:Of the 8 patients treated by microsurgery,3 had complete clipping and good prognosis.No recurrence or hemorrhage was found in the follow-up period of2 years.Cerebral vasospasm,brain edema,brain swelling and focal neurological dysfunction occurred in 4 patients after clipping.The main manifestations were hemiplegia of one limb.One patient underwent internal carotid artery isolation due to internal carotid artery avulsion during operation and complicated with massive cerebral infarction after operation,and eventually died.Among 13 patients tretaed by interventional therapy,1died of extensive subarachnoid hemorrhage 5 days after stent-assisted embolization.2 patients treated by stent-assisted aneurysm embolization,one of them had acute thrombosis during operation,one side of internal carotid artery occluded.After the patient underwent emergent embolectomy and thrombolysis,emergent decompression of bone flaps was operated.The other patient had spontaneous internal carotid artery occlusion 10 days afteroperation.2 patients had focal neurological impairment caused by internal carotid artery occlusion.The main manifestations were hemiplegia and aphasia.One patient had recurrence after operation.Three patients had a good prognosis,no recurrence and no bleeding occurred during the follow-up for 1 year.7 patients were treated with Willis covered stent.One patient died of cerebral vasospasm,circulatory failure and cardiorespiratory arrest after operation.6 patients had no obvious neurological dysfunction and had a good prognosis,there was no recurrence or bleeding after 1 year’s follow-up.Conclusion : microsurgical treatment and interventional treatment are the main treatment methods for internal carotid artery blood blister-like aneurysms.Although different treatment methods do not significantly affect the prognosis of patients with internal carotid artery blood blister-like aneurysms,endovascular interventional treatment can achieve better survival and prognosis than surgical treatment.It is safe and effective to use Willis covered stent in the treatment of internal carotid artery vesicular aneurysms by selecting suitable patients with It is safe and effective to use Willis covered stent in the treatment of internal carotid artery vesicular aneurysms by selecting suitable patients with internal carotid artery blood blister-like aneurysms.It is safe and effective to use Willis covered stent in the treatment of internal carotid artery blood blister-like aneurysms by selecting suitable patients with internal carotid artery vesicular aneurysms.For specific patients with internal carotid artery blood blister-like aneurysms,individualized treatment options should be selected on the basis of full assessment of the patient’s condition and vascular conditions,in order to achieve a better therapeutic effect.