Staged Endovascular Treatment With Stent-Assisted Coiling Followed by Flow Diversion for Ruptured Intracranial Dissecting Aneurysms: A Report of Two Cases

Abstract

Ruptured intracranial dissecting aneurysms are challenging to treat when parent artery sacrifice is unsuitable or technically difficult. Although flow diverters (FDs) enable definitive arterial reconstruction, their use during acute subarachnoid hemorrhage is complicated by the need for dual antiplatelet therapy. We report two patients with ruptured dissecting aneurysms of the internal carotid artery and vertebral artery who underwent a staged endovascular strategy. Stent-assisted coiling (SAC) was performed in the acute phase to protect against rebleeding while preserving the parent artery. Both lesions subsequently demonstrated early recurrence: case 1 showed aneurysm enlargement with rebleeding and later recurrent filling, whereas case 2 developed a new focal dilatation at the proximal stent edge. FD placement was subsequently performed to reconstruct the diseased parent artery. Staged SAC, followed by FD placement, may provide a practical option for selected ruptured dissecting aneurysms by separating immediate protection against rebleeding from definitive parent artery reconstruction.