Ruptured cerebral aneurysms treated by stent-assisted GDC embolization--two case reports with long-term follow-up

Two cases of acutely ruptured cerebral aneurysm of low dome/neck ratio treated by stent-assisted GDC embolization using balloon-expandable coronary stent, and also their long-term follow-up results are reported. After embolization, the basilar trunk aneurysm was completely occluded, and partial occlusion was obtained for the internal carotid (IC)-paraclinoid aneurysm. Oral ticropidine (200 mg/day) was given after the embolization, and no neurological events were seen during long-term follow-up (64-68 months). Follow-up angiograms of the basilar trunk aneurysm at 20 months showed complete occlusion and no in-stent stenosis. Follow-up angiograms of the IC-paraclinoid aneurysm at 52 months showed complete occlusion of the aneurysm, but mild stenosis at the distal end of the stent graft. These cases suggested that stent-assisted GDC embolization is effective for prevention of rebleeding from ruptured aneurysm during long-term observation even with sufficient dose of antiplatelets therapy. Caution should be taken on aneurysmal recanalization and parent artery stenosis due to stent deployment during long-term period.