• M Yashar S Kalani, Joseph M Zabramski, Louis J Kim, Shakeel A Chowdhry, George A C Mendes, Peter Nakaji, Cameron G McDougall, Felipe C Albuquerque, and Robert F Spetzler.
• *Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; ‡Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington.
• Neurosurgery. 2013 Dec 1; 73 (6): 1026-33; discussion 1033.

BackgroundBlister aneurysms of the internal carotid artery (ICA) are uncommon. There is a paucity of data on the long-term outcomes of patients.ObjectiveTo review our experience with the treatment of these lesions.MethodsWe retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed.ResultsSeventeen patients (3 male, 14 female) with 18 blister aneurysms of the ICA were identified. The mean age was 44.6 years (range, 17-72; median, 42 years). Twelve patients (70.6%) presented with aneurysmal subarachnoid hemorrhage. The mean admission Glasgow Outcome Scale score was 4.3 (range, 2-5; median, 5). All patients were initially treated using microsurgical technique with direct clipping (n = 15; 83.3%) or clip-wrapping with Gore-Tex (n = 3, 16.7%). There were 4 cases of intraoperative rupture, all associated with attempted direct clipping; all 4 cases were successfully clipped. Two cases rebled post-treatment. Both rebleeding episodes were managed with endovascular stenting. Follow-up angiography was available for 14 patients and revealed a new aneurysm adjacent to the site of clipping in 1 patient and in-stent stenosis in 2. At the mean follow-up of 74.5 months (median, 73; range, 7-165), the mean Glasgow Outcome Scale score was 4.6 (range, 2-5; median, 5).ConclusionMicrosurgical treatment of blister aneurysms of the ICA results in excellent outcome. In the evolution of treating these friable aneurysms, we have modified our clip-wrapping technique and use this technique when direct clipping is not feasible.

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