• Peter Kan, Ahmad Sweid, Aditya Srivatsan, and Pascal Jabbour.
• Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
• Neurosurgery. 2020 Jan 1; 86 (Suppl 1): S96-S103.

BackgroundThe safety and efficacy of flow diversion (FD) in the treatment of cerebral aneurysms have been reported by many studies. FD has enabled the treatment of complex aneurysms and aneurysms that were previously untreatable by conventional means. It has achieved high rates of obliteration with essentially no recanalization, and its indications have continued to expand, now including ruptured aneurysms, blister aneurysms, and dissecting aneurysms.ObjectiveTo provide a review on the outcomes of studies covering the use of FD in the settings of ruptured, blister, and dissecting aneurysms. In addition, to discuss dual antiplatelet therapy (DAPT) used in preparation for FD deployment in these scenarios, including associated complications with DAPT use in the acute rupture setting.MethodsReferences for this topical review were identified by PubMed searches between January 2000 and January 2019. The search terms "aneurysm", "flow diverter", "stent", "pipeline", "ruptured", "blister", and "dissecting aneurysms" were used.ResultsFD carries a higher complication rate in the acute rupture setting than for unruptured aneurysms. Patient selection is of paramount importance for achieving good functional and angiographic outcomes. DAPT still remains challenging, especially in ruptured aneurysms. Advancements in surface modification of flow diverters can reduce the risk of thromboembolism and perhaps lead to a safer antiplatelet regimen.ConclusionIn summary, FD shows promise to be an effective treatment for ruptured, blister, and dissecting aneurysms.Copyright © 2019 by the Congress of Neurological Surgeons.

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