Turkish Neurosurgery 2017 , Vol 27 , Num 3
Endovascular Treatment of Wide Necked Ruptured Saccular Aneurysms with Flow-Diverter Stent
Enes DUMAN1,Ilker COVEN2,Erkan YILDIRIM1,Cem YILMAZ2,H.Ulas PINAR3
1Baskent University, Medical Faculty, Konya Research Center, Department of Radiology, Konya, Turkey
2Baskent University, Medical Faculty, Ankara Research Center, Department of Neurosurgery, Ankara, Turkey
3Baskent University, Medical Faculty, Konya Research Center, Department of Anesthesiology, Konya, Turkey
DOI : 10.5137/1019-5149.JTN.16324-15.1 AIM: Flow diverter (FD) stents have been used in the treatment of unruptured intracranial aneurysms. There are a few studies that report the use of these devices in ruptured blister-like aneurysms. We present 5 consecutive patients, who had ruptured intracranial wide necked or side branch close to the neck of saccular aneurysms, with no other treatment options, treated with FD stents and coil embolization.

MATERIAL and METHODS: Between September 2012 and April 2015, 139 ruptured aneurysms of 133 consequent patients were treated. Of these, 48 were surgically treated aneurysms. Five of the remaining 85 aneurysms treated with FD stents. Three aneurysms were in the posterior communicating artery, and 2 were in the supraclinoid internal carotid artery (ICA). Partial coil embolization was performed in addition to FD stents in three patients. All patients were treated in the first 3 days after bleeding.

RESULTS: Technical success was 100%. Inappropriate deployment of silk stent and partial thrombus formation occurred in one patient due to the jailed micro-catheter. Inappropriate apposition of stent was corrected with a balloon, and the thrombus resolved with tirofiban, tissue plasminogen activator (t-PA) injections. No other complication or death occurred related to the procedure. One patient who had a giant ICA aneurysm and Fisher grade 4 bleeding died due to vasospasm, cerebral edema and sepsis on the postoperative 13th day. The other patients were followed-up uneventfully with computed tomography angiography (CTA) at 6th month and digital subtraction angiography (DSA) at 12th month.

CONCLUSION: FD stents can be used in the treatment of ruptured large wide necked or side branch close to the neck of saccular aneurysms when other treatment options can not be used. Keywords : Aneurysm, Intracranial, Endovascular treatment, Flow diverter devices, Subarachnoid hemorrhage