Safety and efficacy of staged coiling followed by flow diverter in the treatment of ruptured intracranial aneurysms

Yuanzhi Li; Feng Fan; Zhen Chen; Yajing Ma; Chao Liu; Hang Zhang; Yu Fu; Sheng Guan

doi:10.1007/s10143-024-03174-6

Safety and efficacy of staged coiling followed by flow diverter in the treatment of ruptured intracranial aneurysms

Neurosurg Rev. 2025 Jan 10;48(1):37. doi: 10.1007/s10143-024-03174-6.

Authors

Yuanzhi Li¹, Feng Fan², Zhen Chen¹, Yajing Ma¹, Chao Liu¹, Hang Zhang¹, Yu Fu¹, Sheng Guan³

Affiliations

¹ Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China.
² Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China. fccfanf@zzu.edu.cn.
³ Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China. gsradio@126.com.

PMID: 39792194
DOI: 10.1007/s10143-024-03174-6

Abstract

To evaluate the safety and efficacy of staged coiling followed by flow diverter (FD) in the treatment of ruptured intracranial aneurysms(RIAs). A retrospective analysis was conducted on 20 patients with RIAs treated with staged coiling followed by FD at a single center, between April 2015 and September 2024. Patient demographics, aneurysm characteristics, clinical and imaging outcomes were reviewed. Aneurysm occlusion was determined using the O'Kelly-Marotta (OKM) grading system. All 20 RIAs underwent successful first-stage coiling. In the second stage, 21 FD were deployed, achieving a 100% success rate. The mean maximum diameter of aneurysms was 10.2 (6.3, 20.7) mm, with a neck width of 6.1 (4.2, 7.8) mm. The interval between the first and second stages was 33.3 ± 23 days. One patient (5%) experienced ischemic complications during the first-stage coiling, but no hemorrhagic complications occurred. In the second stage, FD placement was performed without any hemorrhagic or ischemic complications. All 20 patients (100%) received clinical follow-up with a median follow-up time of 182(172.5,190.5) days.14 patients(70%) underwent available DSA follow-up with a median follow-up time of 184 (158.3, 194.8) days, and the OKM grade B was reported in 1 case (7.1%), grade C in 1 case (7.1%), and grade D in 12 cases (85.7%). No aneurysm recurrence was observed. At the last follow-up, all 20 patients had an mRS score of ≤ 1. Staged coiling followed by FD placement for the treatment of RIAs is a safe and effective approach, with a high technical success rate, low perioperative complication rate, and high aneurysm occlusion rate during follow-up.

Keywords: Flow diverter; Ruptured intracranial aneurysms; Staged treatment; Subarachnoid hemorrhage.