Introduction Stent-assisted coiling (SAC) has been developed and used as high effective treatment of wide-neck cerebral aneurysms. Yet, it’s safety is controversial in management of ruptured cerebral aneurysms in acute phase of subarachnoid hemorrhage (SAH). The aim of this study is to evaluate the safety and the feasibility of SAC for acutely ruptured cerebral wide-neck aneurysms.

Methods This study is a retrospective review of patients with ruptured cerebral wide-neck aneurysm who were treated by SAC in acute phase of subarachnoid hemorrhage (<72h) between 2012-2022. In all patients, a loading dose of dual antiplatelets (300 mg clopidegrol plus 325 mg ASA or 180 mg ticagrelor plus 325 mg ASA) is administered before GA induction and dual antiplatelets were continued for 3-6 months. Two loading doses of eptifibatide (180 mcg/kg) were injected after stent implantation and maintenance dose (2 mcg/kg/min) was continued for 4-6 hours after procedure. Dual antiplatelets were continued for 3- 6 months after procedure. Clinical and imaging results were reviewed and analyzed, including complication and outcomes.

Results 108 patients were enrolled in the study with median age of 56 years old (IQR 47-63). Median size of aneurysm was 6 mm (IQR 3.6-9) with median neck size of 4 mm (IQR 3-5.6 mm). 86 patients (79.6%) were presented with good condition (WFNS 1-2). For 18 patients (17%), external ventricular drainage was inserted. 19 patients (17.6%) had procedural-related complication, including 6 (5.6%) aneurysm perforation and 11 (10.2%) in-stent/parent artery thrombosis. Significant ischemia occurred in 16 patients (12%). Seven patients on dual antiplatelets needed ventriculoperitoneal shunt , one complicated with subdural hematoma. Immediate satisfied aneurysm occlusion (Raymond Roy 1 or 2) achieved in 90 aneurysms (84.1%). 90 patients (84.1%) had favorable outcome, including 92% of patients who admitted with good condition (WFNS 1-2) and 55% of patients who presented with loss of consciousness (WFNS 3-5). 8 patients (7.4%) died.

Conclusion SAC is an effective and feasible procedure for acutely ruptured aneurysm. Despite relatively high ischemic complication, favorable outcome could be achieved in majority of patients even in patients with high grade SAH. Usage of Dual antiplatelets in these patients could increase hemorrhagic complications of neurosurgical procedures.

Disclosures H. Baharvahdat: None. F. Qoorchi Moheb Seraj: None. M. Vaezi: None. F. Ebrahimnia: None. R. Gorji: None. S. Najafi: None. H. Pahlavan: None. A. Sadeghian: None. S. Zabihyan: None. P. Sassannejad: None.