Turkish Neurosurgery
Endovascular treatment of wide necked ruptured saccular aneurysms with flow- diverter stent
enes duman1, ilker çöven2, erkan yıldırım1, cem yılmaz2, ulaş pınar3
1başkent üniversitesi, radyoloji, konya,
2başkent üniversitesi, beyin cerrahisi, ankara,
3başkent üniversitesi, anestezi, konya,
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 have ruptured intracranial wide necked or side branch close to the neck of saccular aneurysms, have 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 remaining 85 aneurysms treated with FD stents. Three aneurysms were posterior communicant artery, and 2 were supraclinoid ICA. Partial coil embolization performed in three patients additional to FD stents. All patients were treated in first 3 day after bleeding. Results:Technical success was 100%. Inappropriate deployment of silk stent and partial thrombus formation was occurred in one patient due to the jailed microcatheter. Inappropriate apposition of stent was corrected with a balloon, and thrombus resolved with tirofiban , tPA injections. No other complication or death occurred related to the procedure. One patient who has giant ICA aneurysm and Fisher grade 4 bleeding was died due to vasospasm, cerebral edema and sepsis on postoperative 13th day. The other patients were followed-up with CTA at 6th month and DSA at 12th month uneventfully. 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 cannot be performed.

Corresponding author : enes duman