Blister Aneurysm of Middle Cerebral Artery Division: Stent-Assisted Coiling Using Shelfing Technique

Abstract Blister aneurysms pose significant diagnostic and therapeutic challenge to neurointerventionists as well as neurosurgeons. Fragile nature of these aneurysms with involvement of the adjacent parent artery makes surgical options more difficult and complicated. Various endovascular treatment options such as overlapping stent, parent artery occlusion, and flow diverter placement are available in the present era. Though side wall aneurysms can be managed with flow diverter placement, bifurcation aneurysms are difficult to treat with these devices due to possibility of compromised flow in covered branch arteries. Blister aneurysms of the middle cerebral artery (MCA) are rare, and their treatment can be challenging when they are treated by endovascular methods with either overlapping stent or flow diverter placement. The authors report a case of ruptured MCA trifurcation blister aneurysm treated with shelfing technique using braided stent monotherapy along with coil embolization. The patient had good clinical outcome (modified Rankin’s scale 1 [mRS-1]) at discharge and complete aneurysm occlusion on follow-up angiogram after 6 months.