Introduction: Stenting acutely-ruptured aneurysms with acute subarachnoid hemorrhage (SAH) is generally avoided due to risks associated with dual antiplatelet therapy.
Methods: We retrospectively reviewed our clinical records to identify patients treated during the acute phase of aneurysmal rupture (first 3 days) from 6/2011–6/2016. Those managed with stent-assisted techniques were included. Patients whose aneurysms who underwent stent-based treatment before rupture or after rupture at a subacute stage and those managed surgically were excluded.
Results: 47 patients met inclusion criteria (27 male, 20 female; mean age 38 years, range 23–73); 56 aneurysms were treated in the acute phase. 46/47 patients presented SAH. Aneurysmal dome and neck width averaged 5.7 mm (range 1.7–16.2 mm) and 3.4 mm (range 1.5–7.1), respectively. Single-stent techniques were used in 33 patients (flow-diverters–15, including 3 with coiling; stent-assisted coiling–13; waffle-cone–3; pconus–2). Dual-stent techniques were used in 14 (dual stent-assisted coiling–12; double flow-diverter–2). External ventricular drains (EVD) were placed before embolization in 24 patients and afterwards in 3. Procedure-related thromboembolic complications during the intervention in 4 patients (8.5%) were successfully managed with intraarterial antiplatelet agents. Of 45 surviving patients (96%), 42 patients (27 after stent-assisted coiling, 15 after flow-diverter stent implant) presented complete aneurysm occlusion and modified Rankin Score (mRS) 0–2 at 9–12 month follow-up.
Conclusions: Stenting techniques in ruptured aneurysms can be performed with high degrees of technical success, but adverse events appear more common, especially major procedural thromboembolic complications. EVD placement before stenting must be considered.
