Introduction Endovascular embolization, currently established as the primary treatment for over 70% of ruptured intracranial aneurysms, reflects the rapid evolution of neurointerventional surgery. While traditional microsurgical approaches present obstacles, the challenges are magnified in acute cases due to heightened device limitations and complexities in antiplatelet therapy.

Aim of Study To assess the efficacy and safety of intracranial stent placement in the management of acute ruptured cerebral aneurysms, emphasizing patient selection criteria, procedural nuances, and post-treatment outcomes, within a single-center cohort.

Methods Out of 462 patients with acute aneurysmal subarachnoid hemorrhage (SAH) treated at our institution since 2015, 263 underwent clipping, and 199 received endovascular treatment, with six cases involving stenting in the acute phase. The majority of aneurysmal surgeries, including all six stenting cases, were performed within <12 hours from SAH onset. Stenting was performed under dual or triple antiplatelet therapy. Braided stents or flow diverter devices were used in cases where coils protruded into the parent artery or for fusiform aneurysms. In one case, the posterior inferior cerebellar artery (PICA) originated from the aneurysmal sac.

Results The mean patient age was 50 years, with Hunt-Hess scores ranging 2-4. Four patients achieved a favorable outcome (Modified Rankin Scale, MRS-0) following treatment, while one experienced a prolonged ICU stay (MRS-5). One patient developed delayed aggressive vasospasm, leading to demise on the 10th day post-hemorrhage despite intervention (MRS-6).

Conclusion Intracranial stent placement for acute ruptured cerebral aneurysms necessitates careful patient selection. However, with a personalized approach to antiplatelet therapy, early intervention holds potential for safety and efficacy.