Experience of using low-profile braided stents for the treatment of ruptured intracranial aneurysms in the first 72 hours of subarachnoid hemorrhage

The study objective is to present our experience in the treatment of ruptured cerebral aneurysms using intracranial low-profile braided stents in the first 72 hours of subarachnoid hemorrhage.

Materials and methods. A retrospective analysis of 5 patients’ data was performed. All patients were treated for a ruptured cerebral aneurysm in the period from June 2017 to December 2018 at the Surgut Clinical Hospital for Traumatology. Patients were operated using a low-profile braided stent in the first 72 h of subarachnoid hemorrhage. Clinical data, Hunt—Hess grade, morphology of aneurysms, Raymond— Roy angiographic results, outcomes according to a modified Rankin Scale were evaluated.

Results. All 5 aneurysms are turned off from the bloodstream in the first 72 hours from rupture. The preoperative condition was assessed as mild in 1 patient (Hunt—Hess grade I—II), moderate in 3 (grade III), and ssevere in 1 (grade IV). Stent placement was used to “bail out" situations with coil migration saccular aneurysm (n = 2), for occlusion the broad-based aneurysms (n = 2), for dissecting neurysm occlusion without of coils using (n = 1). Total aneurysm occlusion was achieved in 4 cases (Raymond—Roy I), subtotal in 1 (Raymond—Roy II). Technical difficulties were in 1 case: transient intraoperative in-stent thrombosis, regressed with the super-selective administration of tissue plasminogen activator. A follow-up angiographies demonstrated complete aneurysm occlusion in 4 cases, including “solo" stent placement (Raymond—Roy I); recurrent aneurysm occurred in 1 (Raymond—Roy III), retreatment was required. The favorable outcome of treatment (modified Rankin Scale 0—2) was achieved in 5 cases.

Conclusion. The use of low-profile braided stents for occlusion ruptured cerebral aneurysms in the first 72 hours of subarachnoid hemorrhage is relatively safe and can be used to prevent re-rupture. However, it could be associated with a relatively high risk of periprocedural thromboembolism.

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