Flow-diverter treatment of recanalized ruptured blister aneurysms in the subacute phase: a report of two cases

In Korea, flow-diverting stents (FDSs) for acutely ruptured aneurysms are not reimbursed by the National Health Insurance Service.FDS treatment may be considered when a blister aneurysm recanalizes after conventional reconstructive treatment.We describe two patients with ruptured blister aneurysms who were initially treated with stent-assisted coil embolization.Follow-up digital subtraction angiography (DSA) performed approximately 2 weeks after the procedure demonstrated early recanalization in both patients.After DSA confirmed the absence of vasospasm, a Pipeline embolization device was placed across the diseased parent-artery segment under dual antiplatelet therapy.No periprocedural ischemic complications were documented, and 6-month DSA confirmed complete occlusion in both patients.The modified Rankin Scale score at 6 months was 1 in both patients.In this report, "subacute phase" denotes flow-diverter deployment approximately 14 days after rupture during the index hospitalization, after initial aneurysm securing and angiographic exclusion of vasospasm.This staged rescue strategy may be reasonable for selected rapidly recanalized blister aneurysms when repeat coiling or additional conventional stenting is unlikely to provide durable reconstruction.However, no conclusions about safety can be drawn from two cases.Subacute FDS treatment for recanalized blister aneurysms has rarely been reported in Korea.