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Case report
Flow diverters and a tale of two aneurysms
  1. Gregory A Kuzmik1,
  2. Theresa Williamson1,
  3. Asiri Ediriwickrema1,
  4. Ahmed Andeejani2,
  5. Ketan R Bulsara1,3
  1. 1Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2Department of Radiology and Imaging, Riyadh Military Hospital, Riyadh, Saudi Arabia
  3. 3Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Ketan R Bulsara, Department of Neurosurgery, Yale University School of Medicine, PO Box 208082, New Haven, CT 06520, USA; ketan.bulsara{at}


Flow-diverting devices offer an exciting alternative for the management of large and giant intracranial aneurysms. However, the risk and mechanism of delayed aneurysmal rupture and hemorrhage following placement of these devices are not clearly understood. Two patients with similar symptomatic giant paraclinoid internal carotid artery aneurysms are described. Both patients were treated with SILK flow-diverting devices. In both patients the SILK device was placed without technical complication. The first patient continued to do well 1 year postoperatively with complete aneurysm occlusion. The second patient had a delayed subarachnoid hemorrhage despite markedly decreased filling of the aneurysm immediately following the procedure. Flow-diverting devices are an exciting technology which provide an alternative treatment modality in the management of giant intracranial aneurysms. However, caution must be exercised as the risks of delayed complications have yet to be fully elucidated. Similar aneurysms may have drastically different outcomes due to the unpredictability of this technology.

  • Flow diverter
  • stent
  • aneurysm
  • hemorrhage
  • blood flow
  • atherosclerosis
  • angioplasty
  • angiography
  • artery

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  • GAK and TW contributed equally to this article.

  • Competing interests None.

  • Ethics approval Ethics approval was not required as this brief retrospective case report does not pose any risks to the patients described and does not compromise their confidentiality. The cases have been fully anonymized by removing all references to gender.

  • Provenance and peer review Not commissioned; externally peer reviewed.