Renaissance of Wrapping Materials for Ruptured Internal Carotid Artery Blood Blister-like Aneurysms

Introduction: Blood blister-like aneurysms (BBAs) account for 0.9% to 9.4% of internal carotid artery (ICA) aneurysms. BBAs are characterized by frequent re-ruptures and regrowth both during and after surgery, making them highly challenging for vascular surgeons. No consensus exists regarding a single recommended treatment strategy, whether surgical approach or endovascular approach. Our team at China Medical University Hospital (CMUH) has proposed a multimodal management technique that combines muscle wrapping, surgical clipping, and flow-diverter embolization. This article mainly focuses on exploring the evolution of wrapping materials.

Methods: A thorough literature review was conducted using PubMed, focusing on studies published from 1995 to 2024. Several keywords were used: “ruptured blood blister-like aneurysm,” “internal carotid artery,” “surgical clipping,” and “wrapping materials.” Key articles were selected based on their relevance to wrapping techniques, material types, and clinical outcomes.

Results: The review reveals a renaissance in the use of wrapping materials, including both bioactive and biodegradable options. Autologous materials such as dura mater, muscle, muscle fascia, and pericranium were widely used. Synthetic materials such as gauze, cotton, polytetrafluoroethylene (Teflon), and Gore-Tex were also employed. A Sundt clip graft, which is a vessel-encircling clip made of a metallic spring enclosing a Teflon or Dacron graft, was utilized in several studies. Research indicates that these materials can significantly reduce the risk of re-rupture by providing mechanical support and promoting healing.

Conclusion : The wide variety of wrapping materials offers a promising strategy for the management of ruptured blood blister-like ICA aneurysms. As the field progresses, further research is needed to standardize treatment protocols, optimize material selection, and evaluate long-term outcomes.