• Yong Cheol Lim and Jihye Song.
• Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea.
• World Neurosurg. 2023 Jul 1; 175: e950e958e950-e958.

ObjectiveTo evaluate the long-term feasibility of multiple overlapping stents (≥2) with or without coiling for treating blood blister-like aneurysms (BBAs).MethodsBBAs treated with stent-assisted coiling or stent-only therapy wasincluded. BBAs with atypical anatomical locations, other endovascular or surgical techniques performed, and delayed treatment (>48 hours) were excluded. Medical records of patients and procedures were retrospectively reviewed.ResultsSeventeen patients with BBAs were identified, and 15 were treated with stent-assisted coiling and 2 with stent-only therapy. Triple overlapping stents were performed in seven patients, double stents in nine, and a single stent with coiling in 1. One patient experienced in-stent fibrin formation and received intra-arterial tirofiban. Complementary treatment was required in four patients. Three patients were initially treated with double (3/9) and 1 with triple stents (1/7). Three recurred in the acute period (≤6 weeks) and 1 recurred 14 months after treatment. Three of 17 patients with Hunt Hess grade 5 died early. Thirteen patients were available for long-term angiographic follow-up (13.8 ± 8.9 months). Final angiography showed complete aneurysm occlusion in all patients without in-stent stenosis or perforating vessel occlusion. Clinical follow-up data were available for all 14 surviving patients (66.8 ± 40.9 months). Eight patients had favorable outcomes, five had unfavorable outcomes, and 1 died of a subarachnoid hemorrhage-unrelated cause. Delayed infarct or hemorrhage was not documented.ConclusionsEven in the era of flow diverter stents, the use of multiple overlapping stents with or without coiling can be a feasible alternative for treating ruptured BBAs.Copyright © 2023 Elsevier Inc. All rights reserved.

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