Effect of flow diversion treatment on very small ruptured aneurysms

Ruptured aneurysms of < 2 mm are not amenable to endovascular coiling and therefore pose a significant treatment challenge.

To test recently introduced flow diverters that allow endovascular reconstruction via another method and may represent a new treatment option for such lesions.

Three female patients presented with acute subarachnoid hemorrhage. An aneurysm of < 2 mm was identified in all patients as the cause of bleeding. The aneurysms were located at the C2 segment of the internal carotid in 2 patients and on the basilar bifurcation in the other. All patients had failed early endovascular treatment attempts. Flow diversion with the SILK flow diverter was offered as an alternative in each patient.

SILK deployment successfully eliminated the aneurysms in all 3 instances. One of the aneurysms was excluded from contrast material visualization immediately after stent deployment. Transient thrombotic complication was observed in the case of the basilar artery aneurysm. It resolved with the administration of intraarterial tirofiban. There was no treatment-related morbidity, and none of the aneurysms reruptured after SILK implantation during a clinical follow-up of at least 4 months (range, 4-10 months). Imaging follow-up showed complete vessel remodeling in all cases.

Flow diversion treatment prevented rebleeding during the follow-up period. Reverse remodeling of the concerned vascular segment with delayed disappearance of the aneurysm was observed in each case.