Stent-assisted Embolization for Acutely Ruptured Aneurysms

Abstract

Although stent-assisted embolization is useful for wide-neck aneurysms, this technique is not permitted for acutely ruptured aneurysms in Japan. Consequently, the treatment of choice tends to be staged embolization, in which partial embolization without a stent and stent-assisted tight embolization are used for first and second stages, respectively. Recently, we encountered a case of acutely ruptured aneurysm in which the patient had a very wide neck and partial embolization without a stent was impossible. Instead, we performed stent-assisted embolization; moreover, this procedure was performed in three other cases thereafter. All of the patients presented with acutely ruptured internal carotid artery aneurysms and had very wide necks. Although balloon-assisted embolization was attempted, this approach failed in all cases. Stent-assisted embolization was then performed following rapid clopidogrel loading. We tightly packed the rupture point while loosely packing the portion at the neck. Neuroform EZ® and Atlas® stents were used in one and three cases, respectively. The rupture point was cleared immediately after embolization in all cases, and no rerupture was observed. There was one instance of thrombotic complication due to protrusion of the coil. Additional embolization was required in two cases more than six months later. In conclusion, stent-assisted embolization should be performed for acutely ruptured aneurysms if the use of other methods is not possible.