Predicting Recurrence of Blood Blister-Like Aneurysms: The Importance of Aneurysmal Neck Area

World Neurosurg. 2025 Sep:201:124334. doi: 10.1016/j.wneu.2025.124334. Epub 2025 Jul 29.

Abstract

Background: Blood blister-like aneurysms (BBAs) are distinct aneurysms that mostly develop as small, wide-based structures at the supraclinoid segment of the internal carotid artery, often leading to subarachnoid hemorrhage and causing diagnostic and therapeutic challenges. This study aimed to identify the diagnostic indicators associated with postoperative recurrence of BBAs.

Methods: We retrospectively evaluated the clinical history, angiographic features, three-dimensional parameters, treatment methods, and outcomes of 23 patients with BBA treated at our center. Cases were categorized into three outcomes: no recurrence, stable recurrence, and progressive recurrence, and these groups were compared.

Results: Significant differences were observed in the width, neck length, and neck area between the no recurrence and recurrence groups. The progressive recurrence group had a larger neck area. The no recurrence and stable recurrence groups had higher aspect and K ratios.

Conclusions: Our research highlighted that these parameters could be potential indicators of aneurysm recurrence. Furthermore, our findings suggested that patients with a larger neck area, lower aspect ratio, and K ratio might require additional intervention to prevent aneurysm recurrence.

Keywords: Blood blister-like aneurysm; Diagnostic image; Digital subtraction angiography; Supraclinoid segment.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Ruptured / surgery
  • Carotid Artery, Internal* / diagnostic imaging
  • Carotid Artery, Internal* / surgery
  • Cerebral Angiography
  • Female
  • Humans
  • Intracranial Aneurysm* / diagnostic imaging
  • Intracranial Aneurysm* / surgery
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Subarachnoid Hemorrhage