Considerations and Literature Review for Treating Subarachnoid Hemorrhage due to Blood Blister-Like Aneurysms

Objective: Subarachnoid hemorrhage (SAH) due to blood blister-like aneurysm (BBA) is rare but very risky during treatment. Moreover, there is no established treatment method. In this study, we performed endovascular treatment (EVT) as the first-line treatment on patients with SAH during the subacute phase, and cases were analyzed in this series.Methods: Patients with SAH due to BBA who visited our hospital between April 2021 and March 2023 were enrolled in this study. We waited as long as possible during the acute phase and performed EVT during the subacute phase. We performed stent-assisted coiling (SAC) as the first-line treatment and performed DSA approximately 6 months after treatment.Results: Ninety-six patients with SAH visited our hospital during the study period and six had SAH due to BBAs. There were two males and four females aged 56.2 ± 14.6 years. We performed SAC in five patients, and one died owing to rebleeding before treatment. Two patients received treatments because of rebleeding. One patient died on the day after rebleeding, whereas the other experienced rebleeding and treatments twice and achieved a good outcome. Four patients had good outcomes (modified Rankin scale [mRS]: 0). The surviving patients achieved complete occlusion at follow-up DSA. However, two patients had poor outcomes (mRS: 6).Conclusion: Patients with SAH due to BBA treated in the subacute phase may achieve good outcomes; however, there is a risk of rebleeding during the waiting period, which often causes poor outcomes.