Two Cases of Flow Diverter Placement for Early Recurrence Following Stent-Assisted Coil Embolization for Ruptured Dissecting Cerebral Aneurysms

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Objective: We report 2 cases of ruptured intracranial dissecting aneurysms that were successfully treated with a flow diverter (FD) stent in the subacute phase, following urgent stent-assisted coiling (SAC) embolization.

Case Presentation: Case 1: A 48-year-old male presented with a sudden-onset headache and altered consciousness. CT showed a diffuse subarachnoid hemorrhage (SAH). DSA revealed a right vertebral artery dissecting fusiform aneurysm (VADA). Considering that the perforating and anterior spinal arteries arose from the VADA, SAC was performed to preserve the perforating branch. Follow-up angiography revealed regrowth of the aneurysm without hemorrhage. Case 2: A 37-year-old male was involved in a car accident, followed by a sudden loss of consciousness. CT showed diffuse SAH, and DSA revealed a right internal carotid artery (ICA) blood blister-like aneurysm (BBA) on the anterior wall of the C2 portion. We performed SAC because of the difficulty in urgent high-flow bypass and trapping due to brain swelling. Follow-up angiography revealed regrowth of the aneurysm without hemorrhage. Each treatment involved SAC using the low-profile visualized intraluminal support (LVIS) stent (Terumo, Tokyo, Japan) and FD using the pipeline embolic device. The procedures were performed without complications.

Conclusion: To date, few studies on stepwise treatment with SAC and FD for refractory ruptured cerebral aneurysms, such as VADA and BBA of the ICA, have been reported. In addition to the cases reported, we also reviewed previous articles on treatment results, discussed antiplatelet therapy, and provided tips for the telescoping stent procedure.