Microsurgical versus Endovascular Treatments for Blood-Blister Aneurysms of the Internal Carotid Artery: A Retrospective Study of 83 Patients in a Single Center.

BACKGROUND: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality. Both surgical and endovascular approaches have been used to treat BBAs; however, little is known about their safety and efficacy.

OBJECTIVE: To review our experience with the treatment of BBAs and explore the optimal treatment strategy.

METHODS: A total of 83 patients with BBAs were reviewed retrospectively. The characteristics of the patients and the aneurysms, treatment results, and follow-up outcomes were analyzed.

RESULTS: The cohort comprised 52 females and 31 males with a mean age of 46.6 years; 33 patients were assigned to the microsurgical therapy. Subsequently, 27/33 patients underwent surgical clipping, 4/33 underwent trapping without bypass, 2/33 underwent wrapping, and 50 patients underwent endovascular therapy, including stent-assisted coiling (49 patients) and coiling (1 patient). Intraoperative rupture occurred in 14 and 4 patients in the microsurgical and endovascular groups, respectively. Ischemic events occurred in 16 and 8 patients in the microsurgical and endovascular groups, respectively. At 1-year follow-up, a favorable clinical outcome was achieved in 18 (54.5%) and 38 (76.0%) patients in the microsurgical and endovascular groups, respectively. The multivariate regression model showed that the treatment strategies, Fisher grade, and vasospasm contributed significantly to the prediction of outcome for 1 year.

CONCLUSIONS: BBAs are challenging vascular lesions with poor prognosis. Endovascular treatment may be more effective and safer with better outcomes than surgical approaches.