Arterial suturing followed by clip reinforcement with circumferential wrapping for blister-like aneurysms of the internal carotid artery. 
Blister-like aneurysms of the internal carotid artery (ICA) are very fragile, thin-walled aneurysms.  These lesions are susceptible to premature rupture intraoperatively.  We describe two cases of successful arterial suturing of these blister-like aneurysms of the ICA, followed by a clip reinforcement technique and circumferential wrapping with a silastic sheet.  Two young men presented with a diffuse and dense subarachnoid hemorrhage (SAH) in the basal cistern.  The initial angiogram obtained soon after the SAH showed a broad-based, small bulging appearance of the dorsal wall of the ICA.  Intraoperatively, a very thin-walled aneurysm was identified on the C2 and C1 segment of the ICA.  The aneurysms ruptured abruptly during surgical manipulation.  After application of temporary clips, an aneurysmal tear of the ICA was repaired with 8-0 nylon.  To prevent the regrowth of the aneurysm, clip reinforcement, by circumferential wrapping with a transparent silicone sheet, was added.  The postoperative clinical course was uneventful, although one patient showed transient right hemiparesis due to cerebral vasospasm.  Angiographic studies performed postoperatively showed complete obliteration of the aneurysm as well as a patent ICA lumen in one case and total occlusion of the ICA in the other case.  Both patients were discharged with no neurological deficits.  This technique can be a useful treatment option for these fragile aneurysms in cases where other options, such as direct clips or encircling clips, may be impossible.