Delayed Treatment (≥5 Days) by Flow Diversion of Ruptured Blister-Like Cerebral Aneurysms

Case Series of 8 Consecutive Patients
  • Romain Capocci
  • Eimad Shotar
  • Federico Di Maria
  • Claudia Rolla-Bigliani
  • Amira Al Raaisi
  • Arthur André
  • Jugurtha Mahtout
  • Anne-Laure Boch
  • Vincent Degos
  • Nader Sourour
  • Frédéric ClarençonEmail author
Original Article


Background and Purpose

Ruptured blister-like aneurysms (BLAs) are challenging lesions to treat, without any consensus on their management. Few studies have evaluated the safety and effectiveness of flow diverter stents (FDS) for this indication, with promising results. The goal was to evaluate the safety and effectiveness of a delayed (≥5 days) flow diversion strategy for the treatment of ruptured intracranial BLAs.

Material and Methods

A monocentric retrospective analysis of a prospectively collected database of intracranial aneurysms was performed. Eight consecutive patients with 9 ruptured intracranial BLAs from November 2010 to June 2018 were included in the study. The BLA treatment with FDS was delayed from the rupture (minimum rupture to treatment delay = 5 days, mean = 16.9 ± 9.2 days). Procedure-related complications were systematically recorded. Rebleeding occurrences were systematically assessed. Long-term clinical and angiographic follow-ups were recorded.


No procedure-related death was recorded. Neither early nor late rebleeding was observed and one (12.5%) major procedure-related complication occurred (ischemic stroke). Most of the patients (5/8; 62.5%) had an mRS <2 at discharge. The immediate periprocedural control angiogram showed a complete exclusion of the aneurysm in one patient (12.5%) but at follow-up (mean delay = 19.8 months) all patients had a complete aneurysm occlusion. All patients had a long-term mRS <2.


This case series suggests that a delayed treatment (≥5 days after the hemorrhagic event) of ruptured BLAs with FDS is feasible, and may be safe and effective in terms of rebleeding prevention and long-term angiographic outcome.


Flow diverter stent Blister-like aneurysm Cerebral aneurysm Dissection Antiplatelet therapy 



Basilar artery


Blister-like aneurysm


Cekirge-Saatci grading scale


Digital subtraction angiography


Flow diverter stent


Internal carotid artery




Modified Rankin scale


O’Kelly-Marotta grading scale


Picture archiving and communication system


Posterior cerebral artery


Raymond-Roy grading scale


Transient ischemic attack


Conflict of interest

R. Capocci, E. Shotar, F. Di Maria, C. Rolla-Bigliani, A. Al Raaisi, A. André, J. Mahtout, A.-L. Boch, V. Degos, N. Sourour and F. Clarençon declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Romain Capocci
    • 1
  • Eimad Shotar
    • 1
    • 2
  • Federico Di Maria
    • 3
  • Claudia Rolla-Bigliani
    • 1
  • Amira Al Raaisi
    • 1
  • Arthur André
    • 2
    • 4
  • Jugurtha Mahtout
    • 5
  • Anne-Laure Boch
    • 4
  • Vincent Degos
    • 2
    • 5
  • Nader Sourour
    • 1
  • Frédéric Clarençon
    • 1
    • 2
    Email author
  1. 1.Department of NeuroradiologyPitié-Salpêtrière Hospital, APHPParisFrance
  2. 2.Sorbonne University. Pierre and Marie CurieParisFrance
  3. 3.Department of NeuroradiologyFoch HospitalSuresnesFrance
  4. 4.Department of NeurosurgeryPitié-Salpêtrière HospitalParisFrance
  5. 5.Department of Neuro-Intensive CarePitié-Salpêtrière HospitalParisFrance

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