Blood blister-like aneurysms of the internal carotid artery

Blood blister-like aneurysms (BBA) originate at non-branching sites of the internal carotid artery (ICA), these vascular lesions are rare and constitute approximately 1% of all intracranial aneurysms. They are small, with extremely fragile walls and a poorly defined broad-based neck. BBA tend to have a precipitous clinical course, enlarging rapidly, these have been associated with significant morbidity and mortality including rebleeding, regrowth, and ischemic complications; therefore their diagnosis is essential for proper management and depends of its high suspicion and careful evaluation of computed tomography angiogram (CTA) and digital substraction angiography (DSA). Various surgical and endovascular strategies have been attempted for these lesions, but the definitive treatment is controversial even. This paper attempts to describe the clinicopathological features as well as elements important for diagnosis and treatment.