Anterior Communicating Artery Aneurysm: Blister-Like Aneurysm of the Anterior Communicating Artery Treated by Flow Diversion Two Weeks After Subarachnoid Hemorrhage

  • Ivan LylykEmail author
  • Rene Viso
  • Carlos Bleise
  • Esteban Scrivano
  • Pedro LylykEmail author
Living reference work entry


A ruptured blister-like aneurysm was found on the anterior communicating artery (AcomA) of a patient who presented with an intense headache which had started 3 days ago. The patient was found to have a subarachnoid hemorrhage (SAH) and remained in the ICU without complications. Twelve days after the hemorrhage, dual antiplatelet medication was initiated. Two days later, a low-profile flow diverter device (FRED Jr., MicroVention) was successfully implanted. This case illustrates the benefits of using endovascular reconstructive techniques on the vessel when intrasaccular occlusion of the aneurysm is not technically feasible. Once an aneurysm has been completely occluded by an extrasaccular flow-diverting device, recurrence of this aneurysm is very unlikely. We will also discuss the possibility of starting dual antiplatelet medication in the acute phase after SAH. Flow diversion in the acute phase after SAH is the main topic of this chapter.


Anterior communicating artery Subarachnoid hemorrhage Flow diversion Ruptured blister aneurysm Dual antiplatelet medication FRED Jr 


  1. Aydin K, Arat A, Sencer S, Hakyemez B, Barburoglu M, Sencer A, İzgi N. Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg. 2015 Mar;7(3):202–9. Scholar
  2. Bojanowski MW, Weil AG, McLaughlin N, Chaalala C, Magro E, Fournier JY. Morphological aspects of blister aneurysms and nuances for surgical treatment. J Neurosurg. 2015 Nov;123(5):1156–65. Scholar
  3. Cerejo R, Bain M, John S, Hardman J, Moore N, Hussain MS, Toth G. Flow diverter treatment of cerebral blister aneurysms. Neuroradiology. 2017 Dec;59(12):1285–90. Scholar
  4. Chalouhi N, Zanaty M, Tjoumakaris S, Gonzalez LF, Hasan D, Kung D, Rosenwasser RH, Jabbour P. Treatment of blister-like aneurysms with the pipeline embolization device. Neurosurgery. 2014;74(5):527–32. Discussion 532. Scholar
  5. Çinar C, Oran İ, Bozkaya H, Ozgiray E. Endovascular treatment of ruptured blister-like aneurysms with special reference to the flow-diverting strategy. Neuroradiology. 2013 Mar;55(4):441–7. Scholar
  6. Dabus G, Grossberg JA, Cawley CM, Dion JE, Puri AS, Wakhloo AK, Gonsales D, Aguilar-Salinas P, Sauvageau E, Linfante I, Hanel RA. Treatment of complex anterior cerebral artery aneurysms with pipeline flow diversion: mid-term results. J Neurointerv Surg. 2017 Feb;9(2):147–51. Scholar
  7. Dornbos D 3rd, Powers CJ. Acute distal migration of a flow diverting stent. J Clin Neurosci. 2017 Oct;44:223–5. Scholar
  8. Gonzalez AM, Narata AP, Yilmaz H, Bijlenga P, Radovanovic I, Schaller K, Lovblad KO, Pereira VM. Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol. 2014 Jan;83(1):197–205. Scholar
  9. Hu YC, Deshmukh VR, Albuquerque FC, Fiorella D, Nixon RR, Heck DV, Barnwell SL, McDougall CG. Histopathological assessment of fatal ipsilateral intraparenchymal hemorrhages after the treatment of supraclinoid aneurysms with the pipeline embolization device. J Neurosurg. 2014 Feb;120(2):365–74. Scholar
  10. Ishikawa T, Nakamura N, Houkin K, Nomura M. Pathological consideration of a "blister-like" aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery. 1997;40(2):403–5. Discussion 405–6CrossRefGoogle Scholar
  11. Karthikeyan YR, Kataria R, Sinha VD. Unruptured anterior communicating artery aneurysm with co-existing blister aneurysms: case report and review of literature. Romanian Neurosurgery. 2017;31(2):207–10. Scholar
  12. Kung DK, Policeni BA, Capuano AW, Rossen JD, Jabbour PM, Torner JC, Howard MA, Hasan D. Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg. 2011 Apr;114(4):1021–7. Scholar
  13. Lang ST, Assis Z, Wong JH, Morrish W, Mitha AP. Rapid delayed growth of ruptured supraclinoid blister aneurysm after successful flow diverting stent treatment. J Neurointerv Surg. 2017 Apr;9(4):e16. Scholar
  14. Liu Z, Zhang S, Wang S, Chen Q. Management of blood blister-like aneurysms of the internal carotid artery: lessons learned from direct clipping in 22 cases. World Neurosurg. 2017 Dec;108:618–26. Scholar
  15. Mazur MD, Taussky P, MacDonald JD, Park MS. Rerupture of a blister aneurysm after treatment with a single flow-diverting stent. Neurosurgery. 2016 Nov;79(5):E634–8. Scholar
  16. Meling TR, Sorteberg A, Bakke SJ, Slettebø H, Hernesniemi J, Sorteberg W. Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg. 2008 Apr;108(4):662–71. Scholar
  17. Mokin M, Chinea A, Primiani CT, Ren Z, Kan P, Srinivasan VM, Hanel R, Aguilar-Salinas P, Turk AS, Turner RD, Chaudry MI, Ringer AJ, Welch BG, Mendes Pereira V, Renieri L, Piano M, Elijovich L, Arthur AS, Cheema A, Lopes DK, Saied A, Baxter BW, Hawk H, Puri AS, Wakhloo AK, Shallwani H, Levy EI, Siddiqui AH, Dabus G, Linfante I. Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. J Neurointerv Surg. 2018. pii: neurintsurg-2017-013701;
  18. Ogawa A, Suzuki M, Ogasawara K. Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery. 2000;47(3):578–83. Discussion 583–6PubMedGoogle Scholar
  19. Park JH, Park IS, Han DH, Kim SH, Oh CW, Kim JE, Kim HJ, Han MH, Kwon OK. Endovascular treatment of blood blister-like aneurysms of the internal carotid artery. J Neurosurg. 2007;106(5):812–9.CrossRefGoogle Scholar
  20. Peschillo S, Cannizzaro D, Caporlingua A, Missori P. A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms. AJNR Am J Neuroradiol. 2016;37(5):856–61. Scholar
  21. Rouchaud A, Brinjikji W, Cloft HJ, Kallmes DF. Endovascular treatment of ruptured blister like aneurysms: a systematic review and meta-analysis with focus on deconstructive versus reconstructive and flow-diverter treatments. AJNR Am J Neuroradiol. 2015;36(12):2331–9. Scholar
  22. Turowski B, Macht S, Kulcsár Z, Hänggi D, Stummer W. Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-stent): do we need to rethink our concepts? Neuroradiology. 2011;53(1):37–41. Scholar
  23. Yang C, Vadasz A, Szikora I. Treatment of ruptured blood blister aneurysms using primary flow-diverter stenting with considerations for adjunctive coiling: a single-Centre experience and literature review. Interv Neuroradiol. 2017;23(5):465–76. Scholar
  24. Yoon JW, Siddiqui AH, Dumont TM, Levy EI, Hopkins LN, Lanzino G, Lopes DK, Moftakhar R, Billingsley JT, Welch BG, Boulos AS, Yamamoto J, Tawk RG, Ringer AJ, Hanel RA. Endovascular neurosurgery research group. Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms. Neurosurgery. 2014;75(4):419–29. Discussion 429. Scholar
  25. Yu D-W, Jung Y-J, Choi B-Y, Chang C-H. Subarachnoid hemorrhage with negative baseline digital subtraction angiography: is repeat digital subtraction angiography necessary? J Cerebrovasc Endovasc Neurosurg. 2012;14(3):210–5. Scholar

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Clinica La Sagrada Familia, ENERIBuenos AiresArgentina
  2. 2.Ciudad Autónoma de Buenos AiresClinica La Sagrada Familia, ENERIBuenos AiresArgentina

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