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 (SAH)
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. 2
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 blood – blister like aneurysm at the branching
point of supraclinoid ICA in a patient allergic to ASA.
