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

Blister aneurysmspose significant diagnostic and therapeutic challenge to neurointerventionists as well as neurosurgeons. Fragile nature of these aneurysmswith 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 diverterplacement are available in the present era. Though side wall aneurysmscan be managed with flow diverterplacement, bifurcation aneurysmsare difficult to treat with these devices due to possibility of compromised flow in covered branch arteries. Blister aneurysmsof 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 diverterplacement. The authors report a case of ruptured MCA trifurcation blister aneurysmtreated 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 aneurysmocclusion on follow-up angiogram after 6 months.