Use of flow-diverting stents in the treatment of ruptured intracranial artery dissections.

Background: Flow-diverting stents have rapidly become widespread as the preferred treatment for intracranial aneurysms. They function by optimizing blood flow within the parent vessel to reduce shear stress in the aneurysm, facilitating thrombus formation within the aneurysm, and providing a scaffold for endothelialization and vascular remodeling. Early literature indicates this mechanism also applies to the treatment of ruptured intracranial aneurysms and unruptured intracranial artery dissections, demonstrating favorable occlusion rates. We highlight a novel application of flow-diverting stents in the treatment of ruptured intracranial artery dissections.

Case description: A retrospective chart review was performed of two adult patients suffering from ruptured middle cerebral artery dissections, in which a Flow Re-direction Endoluminal Device X (FRED X stent, Microvention^™, USA) was deployed across the dissection. Utilizing both the flow diverting and vascular remodeling properties of the FRED X stent, both patients achieved hemostasis, maintenance intraluminal patency, and ultimately resolution of hemorrhage without any treatment-related complications. Short-term follow-up revealed no bleeding recurrence.

Conclusion: Flow-diverting stents show promise as a viable option for managing ruptured intracranial artery dissections. However, further prospective studies are recommended to evaluate their efficacy and long-term outcomes comprehensively.