Flow diverting stents in acutely ruptured intracranial aneurysms: a single centre experience of 40 consecutive cases

Certain subsets of acutely ruptured intracranial aneurysms (IAs) may require treatment with flow diverting stents (FDS); however, use of FDS in this context warrants antiplatelet therapy which may increase the risk of further haemorrhage. Here we present our single centre experience of 40 consecutive patients.

We retrospectively reviewed our institutional databases for all patients between 2011 and 2024 with acutely ruptured IAs treated using FDS alone or with simultaneous coiling within 20 days of haemorrhage. Primary outcome was modified Rankin Score (mRS) at latest follow-up. Secondary outcomes were aneurysm occlusion rate and procedure-related complications.

Forty patients met the inclusion criteria: 22 females; mean age 44.7 years (range 18-66). These included 28 blister-like, 5 fusiform, 4 dissecting and 3 saccular aneurysms, with 73% in the anterior circulation. Median time to FDS insertion was 1.5 days from ictus. Favourable functional outcome (mRS 0-2) was observed in 75%. Overall mortality rate was 13% and procedure-related mortality rate was 5%. Complete aneurysm occlusion rate was 97% on follow-up imaging. Procedure-related complications occurred in 18%, with 8% aneurysm rebleed rate, and 8% in-stent thrombosis rate on follow-up imaging (this group of three patients includes the only two patients treated with single antiplatelet therapy (SAPT)).

Our series yielded favourable clinical outcomes and excellent aneurysm occlusion rate following FDS treatment of ruptured IAs. Complications are not negligible, especially the thrombotic risk associated with SAPT use. However, given the innate high mortality risk of aneurysmal subarachnoid haemorrhage, FDS remain a useful alternative for aneurysms unsuitable for traditional endovascular treatment options.