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Using of stent in acute or subacute setting is challenging. The author reported the results in treatment of 11 ruptured aneurysm cases with one kind of flow diverter, Pipeline Embolization Device (PED). All cases were extracted from prospective registry involving 3 Australian neurointerventional sites. Treatments were performed in the early setting (up to 26 days after 1st bleed). Most of the cases were fusiform or dissecting blister like aneurysm. Some of them had failed prior endovascular treatment by coiling or coiling with stenting. The PED treatment could be with or without additional coil filling. No significant morbidity was observed. However, they found 2 interesting reruptures after PED treatment resulting in deaths. Both of them were treated without additional coils; one bled immediately intraprocedural, the other one bled on day 8 after treatment.
In our practice, we perform aneurysm coiling in ruptured cases without stenting. Balloon remodeling technique is used if necessary. Leave the patient for any surgical opportunity might be necessary during acute period. Aneurysm remnant will be evaluated and treated in a stabilized stage. However, in setting of ruptured dissecting or uncoilable aneurysm, stenting is still required in selected case.