Delayed Treatment (≥5 Days) by Flow Diversion of Ruptured Blister-Like Cerebral Aneurysms

Abstract

Ruptured blister-like aneurysms (BLAs) are challenging lesions to treat, without any consensus on their management. Few studies have evaluated the safety and effectiveness of flow diverter stents (FDS) for this indication, with promising results. The goal was to evaluate the safety and effectiveness of adelayed (≥5days) flow diversion strategy for the treatment of ruptured intracranial BLAs. Amonocentric retrospective analysis of aprospectively collected database of intracranial aneurysms was performed. Eight consecutive patients with 9 ruptured intracranial BLAs from November 2010 to June 2018were included in the study. The BLA treatment with FDS was delayed from the rupture (minimum rupture to treatment delay = 5days, mean = 16.9 ± 9.2days). Procedure-related complications were systematically recorded. Rebleeding occurrences were systematically assessed. Long-term clinical and angiographic follow-ups were recorded. No procedure-related death was recorded. Neither early nor late rebleeding was observed and one (12.5%) major procedure-related complication occurred (ischemic stroke). Most of the patients (5/8; 62.5%) had an mRS <2 at discharge. The immediate periprocedural control angiogram showed acomplete exclusion of the aneurysm in one patient (12.5%) but at follow-up (mean delay = 19.8months) all patients had acomplete aneurysm occlusion. All patients had along-term mRS <2. This case series suggests that adelayed treatment (≥5days after the hemorrhagic event) of ruptured BLAs with FDS is feasible, and may be safe and effective in terms of rebleeding prevention and long-term angiographic outcome.