Aneurysm Treatment with Flow Diverters and Stents

Device Characteristics

Conventional stents primarily serve as a scaffold to prevent coil herniation into the parent vessel during coil embolization (stent-assisted coiling) 1
Conventional stents have lower mesh density primarily designed to support coils while maintaining branch vessel patency 2

Wide-necked saccular aneurysms that are not amenable to primary coiling can be treated with stent-assisted coiling 3
Smaller aneurysms requiring immediate occlusion can be treated with stent-assisted coiling 2

Both flow diverters and stents require dual antiplatelet therapy, but this is particularly critical with flow diverters due to higher thrombogenicity 3
The use of stents or flow diverters in ruptured aneurysms is associated with higher risk of hemorrhagic complications, particularly with ventriculostomy 4

The American Heart Association recommends that the use of stents or flow diverters should be avoided in the acute phase whenever a ruptured aneurysm can be treated by primary coiling or clipping 3
Clipping might be preferred over coiling or flow diversion for younger patients (<40 years) due to better long-term protection from rerupture 4
Coiling is indicated in preference to clipping for ruptured aneurysms in the posterior circulation 3
Clipping may be superior for ruptured Middle Cerebral Artery aneurysms 4

For patients with ruptured wide-neck aneurysms not amenable to surgical clipping or primary coiling, endovascular treatment with stent-assisted coiling or flow diverters is reasonable to reduce rebleed risk, as recommended by the American Stroke Association 3
For patients with ruptured fusiform/blister aneurysms, flow diverters are reasonable to reduce mortality, according to the American Stroke Association guidelines 3
For patients with ruptured saccular aneurysms amenable to either primary coiling or clipping, stents or flow diverters should not be used due to higher complication risk, as stated by the American Stroke Association 3