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CC BY 4.0 · J Neurol Surg Rep 2025; 86(04): e194-e197
DOI: 10.1055/a-2707-0515
Case Report

Flow Diversion for Ruptured Tiny Internal Carotid Artery Aneurysm in Patient Allergic to Acetylsalicylic Acid: Case Report and Literature Review

Authors

  • Kalousek Vladimir

    1   Department of Radiology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia

  • Ozretić David

    2   Department of Diagnostic and Interventional Neuroradiology, University Hospital Center Zagreb, Zagreb, Croatia

  • Bilandzic Josko 

    3   Department of Neurosurgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
    4   Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia

  • Rotim Kresimir

    4   Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
    5   Department of Anatomy and Physiology, J. J. Strossmayer University of Osijek Faculty of Medicine, Osijek, Croatia

  • Culo Branimir

    1   Department of Radiology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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Abstract

Introduction

Female patient, age 50, allergic to acetylsalicylic acid (ASA) presented to the emergency department of our institution with spontaneous and severe headache.

Case Report

Emergent brain MSCT and CTA scan showed subarachnoid hemorrhage with aneurysm in the C7 segment of left internal carotid artery (ICA). Prasugrel monotherapy was started and she underwent endovascular aneurysm occlusio. Small, atypically shaped aneurysm was found at the origin of anterior choroidal artery (AChA). Flow diverter stent was placed in the left C7 segment. One single coil was deployed in the sac. She was discharged without any neurological sequelae with prasugrel monotherapy. Two years after the procedure, aneurysm was completely occluded with normal flow in left ICA and its branches.

Discussion

Here, we describe case of blood-blister like aneurysm (BBA) at the origin of left AChA. There is still no consesus regarding optimal treatment strategy for BBAs. Our experience shows it is possible to treat BBA with flow diversion even in the acute setting and near origins of ICA branches. Flow diversion needs to be reinforced with aneurysm coiling in the case of ruptured aneurysm. Due to patient's ASA allergy, we opted for prasugrel monotherapy which proved to be both safe and effective antiplatelet therapy after flow diverter placement.

Conclusion

To the best of our knowledge this is first published case in which coiling with flow diversion was used to treat BBA at the branching point of supraclinoid ICA in a patient allergic to ASA.

Keywords

blood-blister aneurysm - flow diverter - antiplatelet monotherapy - subarachnoid hemorrhage

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during this study.


Contributors' Statement

V.K. contributed to the investigation, conceptualization, and preparation of the original draft. K.R. provided supervision and contributed to writing, review, and editing. J.B. and B.C. were involved in writing, review, and editing. D.O. contributed to conceptualization and the preparation of the original draft.


Ethical Approval

Our institution does not require ethical approval for reporting individual cases or case series.


Informed consent

Informed consent for publication was provided by the patient.




Publication History

Received: 27 June 2025

Accepted: 21 September 2025

Accepted Manuscript online:
23 September 2025

Article published online:
06 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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