Treatment of two blood blister-like aneurysms with flow diverter stenting

Purpose Neurosurgical and endovascular treatment of fragile and recurrent aneurysms of the non-branching portion of the internal carotid artery, known as blister-like aneurysms, is challenging. The aim of this paper is to describe two cases of ruptured blister-like aneurysms of the internal carotid artery and of the vertebral artery at the origin of the postero-inferior cerebellar artery, which were both treated with flow diverter (FD) stents. Methods Two patients with a sub-arachnoid hemorrhage secondary to the rupture of a blister-like aneurysm were treated with a Pipeline (ev3, Irvine, California, USA) stent. Digital subtraction angiography and clinical follow-up were carried out. Results Both patients treated with FD stents had an excellent clinical (modified Rankin Scale, mRS 0) and angiographic outcome. In both cases the aneurysms were completely excluded after 6 months. Conclusions Although the use of this endovascular approach is still debated because of poor experience and pharmacological limitations, FD stents may represent a valid alternative approach for treatment of this aneurysm subtype.