2025 Volume 53 Issue 5 Pages 333-338
Flow diverter (FD) stents have shown high efficacy in treating large aneurysms; however, their effectiveness in aneurysms involving branching vessels remains uncertain. We report two cases in which FD placement combined with coil embolization successfully treated large ruptured internal carotid-posterior communicating artery (IC-PC) aneurysms.
Case 1: A 72-year-old female presented with headache and was diagnosed with subarachnoid hemorrhage due to a ruptured right IC-PC aneurysm. The aneurysm measured 10 mm with a wide neck, and the posterior communicating artery (Pcom) originated from the aneurysm dome in a nonfetal configuration. Despite initial coil embolization in the acute phase, recanalization was observed after 8 months, leading to combined FD-coil treatment. Angiography performed 12 months later showed Pcom narrowing, complete aneurysm obliteration, and O’Kelly-Marotta (OKM) scale C.
Case 2: A 72-year-old female presented with altered consciousness and was diagnosed with subarachnoid hemorrhage from a ruptured left IC-PC aneurysm. The 13-mm aneurysm had Pcom branching near the neck, with similar P1 and Pcom diameters. Initial coil embolization was performed on the same day, but recanalization occurred after 2 months, prompting a combined FD-coil treatment. While the Pcom was visible on internal carotid artery angiography immediately after treatment, the 10-month follow-up imaging showed complete aneurysm occlusion (OKM scale D) and Pcom disappearance.
We experienced two cases where combined FD-coil treatment was successful in treating ruptured IC-PC aneurysms with recanalization after coil embolization. FD placement is considered an option for large IC-PC aneurysms that are difficult to treat using conventional treatments.
