What is the effectiveness of endovascular flow-diverting stent treatment for blood blister aneurysms in the internal carotid artery (ICA) ophthalmic segment?

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Last updated: April 6, 2025 • View editorial policy

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From the Guidelines

Endovascular flow diverting stent treatment is a reasonable option for blood blister internal carotid artery ophthalmic segment aneurysms, as it can reduce the risk of rebleed and mortality, according to the 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage 1. The effectiveness of this treatment approach is supported by the guideline, which states that for patients with aSAH from ruptured fusiform/blister aneurysms, the use of flow diverters is reasonable to reduce mortality 1. Some key points to consider when using endovascular flow diverting stent treatment for blood blister aneurysms include:

  • The need for dual antiplatelet therapy with aspirin and clopidogrel for at least 3-6 months post-procedure, followed by aspirin monotherapy for 6-12 months or longer.
  • The risks associated with the procedure, including thromboembolic complications, in-stent stenosis, and delayed rupture.
  • The importance of close angiographic follow-up, typically at 6 months and 1 year post-treatment. The guideline also emphasizes the importance of evaluating the ruptured aneurysm by specialist(s) with endovascular and surgical expertise to determine the relative risks and benefits of surgical or endovascular treatment according to patient and aneurysm characteristics 1. Overall, endovascular flow diverting stent treatment is a viable option for blood blister internal carotid artery ophthalmic segment aneurysms, and its use can be supported by the latest guideline recommendations 1.

From the Research

Effectiveness of Endovascular Flow Diverting Stent Treatment

The effectiveness of endovascular flow diverting stent treatment in blood blister internal carotid artery ophthalmic segment aneurysms can be evaluated based on several studies.

  • The study by 2 reported that LVIS stent-assisted coil embolization is effective in preventing re-rupture of blood blister-like aneurysms, with complete occlusion confirmed in 92% of aneurysms at follow-up angiography.
  • Another study by 3 compared the outcomes of endovascular treatment of large or giant internal carotid artery aneurysms with flow-diverter stents alone or in combination with coils, and found that the aneurysm was completely occluded in 72.7% of patients at 1-year follow-up.
  • The study by 4 reported that flow diversion for internal carotid artery aneurysms resulted in complete aneurysm occlusion in 61% of patients at 6-month follow-up and 69% at the latest follow-up, with a mean of 18 months.
  • A review of endovascular treatment options for blister aneurysms by 5 found that flow diversion has been associated with higher technical success rates and similar clinical outcomes compared with non-flow diverting treatment methods.

Complications and Outcomes

The studies also reported on the complications and outcomes of endovascular flow diverting stent treatment for blood blister internal carotid artery ophthalmic segment aneurysms.

  • The study by 2 reported that postoperative symptomatic ischemia was confirmed in 33% of patients, and all 4 patients suffered severe subarachnoid hemorrhage.
  • The study by 3 found that the mortality rate due to procedure-related and/or neurological complications was 2.2%, and 88.6% of patients had a favorable neurological outcome at 12 months after the procedure.
  • The study by 4 reported that postprocedural intracranial ischemia or hemorrhage was seen in 24% of patients, including two aneurysm ruptures after flow diversion, and related major long-term functional decline or mortality was seen in 6% of patients.
  • A case report by 6 described the use of aspirin monotherapy in flow diversion of selected internal carotid artery aneurysms, with successful treatment and no complications reported.

Treatment Strategies

The studies suggest that endovascular flow diverting stent treatment can be an effective treatment strategy for blood blister internal carotid artery ophthalmic segment aneurysms.

  • The study by 2 used LVIS stent-assisted coil embolization as the initial treatment, with a second LVIS stent deployed as an overlapping stent if necessary.
  • The study by 3 used flow-diverter stents alone or in combination with coils, and found that the combination of flow diversion and coiling resulted in a higher aneurysm occlusion rate and reduced the need for retreatment.
  • The study by 4 used flow diversion as the primary treatment strategy, and reported that complete aneurysm occlusion was achieved in 61% of patients at 6-month follow-up and 69% at the latest follow-up.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Endovascular treatment of blister aneurysms.

Neurosurgical focus, 2017

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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