A novel treatment of a patient with a giant ruptured middle cerebral artery aneurysm by acute coiling followed by scheduled Pipeline flex placement

Objective Flow diversion in the acute phase of aneurysm rupture or giant aneurysm is limited by the need for dual antiplatelet therapy and the risk of delayed aneurysm rupture. Here, the authors report a scheduled flow-diversion concept for the endovascular treatment of a giant intra-dural aneurysm. Methods A 54-year-old female patient with a ruptured giant middle cerebral artery aneurysm underwent coiling in the acute phase following 1-month scheduled Pipeline flex placement. Results The acutely ruptured giant middle cerebral artery aneurysm was treated by flow diversion scheduled at 1 month after conventional coiling. The patient tolerated this treatment strategy well without any neurological deficits after the procedure and during the 3-month follow-up. The aneurysm showed nearly complete obliteration on 3-month follow-up angiogram, and a 6- to 12-month follow-up was scheduled. Conclusions This strategy may be considered as an option in patients presenting with ruptured or unruptured giant intra-dural aneurysms.