Reconstructive endovascular treatment of a ruptured blood blister-like aneurysm of anterior communicating artery

Blood blister-like aneurysms (BBA) consist of focal wall defects covered with thin fibrous tissue correlated with the marked fragility of their wall; this concept is very important for deciding the right treatment of the latter. Until 2008, it was thought that this type of aneurysm almost exclusively affected the internal carotid artery, and in particular, of its dorsal portion. Subsequently, it was discovered that the BBA may also be present on the anterior communicating artery and on the posterior cranial fossa vessels. In this article, we present a case of anterior communicating artery (AComA) BBA and discuss the unique diagnostic and therapeutic aspects of this vascular lesion. Treatment requires an experienced team of vascular and endovascular neurosurgeons to treat this hazardous group of aneurysms; endovascular stenting techniques avoid maneuvres on the aneurysm itself and should therefore be judged as the lowest risk and first-choice procedures available. We found no reports in the English-language literature of BBA that arose from the AComA treated by a Flow-diverter stent (FDS) in the acute phase. BBA constitute technically challenging lesions that may occur at the AComA. Endovascular treatment offers a lower morbidity-mortality compared with surgical approaches; FDS appear to be a promising strategy.