Flow diversion for acutely ruptured intracranial aneurysms: A single-center retrospective analysis of 30 consecutive cases

Arevik Abramyan; Mena Samaan; Kaustav Chattopadhyay; Siddhant Kumarapuram; Srihari Sundararajan; Hai Sun; Emad Nourollah-Zadeh; Sudipta Roychowdhury; Gaurav Gupta

doi:10.4103/bc.bc_132_24

Flow diversion for acutely ruptured intracranial aneurysms: A single-center retrospective analysis of 30 consecutive cases

Brain Circ. 2025 Apr 9;11(2):135-142. doi: 10.4103/bc.bc_132_24. eCollection 2025 Apr-Jun.

Authors

Arevik Abramyan¹, Mena Samaan¹, Kaustav Chattopadhyay¹, Siddhant Kumarapuram¹, Srihari Sundararajan², Hai Sun¹, Emad Nourollah-Zadeh³, Sudipta Roychowdhury², Gaurav Gupta¹

Affiliations

¹ Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, University Radiology, New Brunswick, NJ, USA.
² Department of Interventional Radiology, Robert Wood Johnson Medical School, University Radiology, New Brunswick, NJ, USA.
³ Department of Neurology, Robert Wood Johnson Medical School, RUTGERS University, New Brunswick, NJ, USA.

Abstract

Objectives: When presented with acutely ruptured aneurysms, neurosurgeons may elect to use flow diverters (FDs). However, with the limited evidence concerning their safety and the potential thromboembolic and hemorrhagic complications, their use is extremely infrequent and often quite limited. In this study, we evaluated treatment-related complications, as well as clinical and radiological outcomes, in patients treated with FD stents for acutely ruptured intracranial aneurysms.

Materials and methods: We conducted a retrospective review of patients treated with FDs within 15 days postsubarachnoid hemorrhage from 2012 to 2024. Patient demographics, aneurysm characteristics, procedural specifics, along with clinical and imaging follow-ups were assessed.

Results: The study included 30 patients with a mean age of 55.6 years. Most aneurysms were located within the anterior circulation and were either small or medium-sized. Morphologically, aneurysms were saccular (43.3%), blister-like (40%), and fusiform/dissecting (16.7%). The mean time from rupture onset to treatment was 4.4 days. FD release was successfully achieved in all cases. Posttreatment rebleeding occurred in 10% of patients, ischemic complications in 6.7%, and treatment-related mortality was 6.6%, with an overall mortality of 13.3%. At discharge, 70% of patients achieved a favorable functional outcome. The mean available radiological follow-up period was 26 months, with complete aneurysm occlusion observed in 57.1% of patients at 1 month and in 100% of those available (40%) for follow-up after 1 year.

Conclusions: Flow diversion for acutely ruptured aneurysms demonstrates promising outcomes, although careful patient selection and alternative treatment consideration are essential. Future prospective, multicenter studies are needed to validate preliminary findings and optimize treatment protocols for this high-risk patient population.

Keywords: Acute stroke; flow diversion; fredx; low-profile visualized intraluminal support blue; pipeline embolization device; subarachnoid hemorrhage; surpass evolve.