AUTHOR=Yan Yazhou , Zhu Shijie , Yao Hao , Wu Yina , Lu Zhiwen , Fang Yibin , Zhao Kaijun , Huang Qinghai 

TITLE=Retreatment with a flow diverter for recurrent blood blister-like aneurysms after embolization: A single-center case series

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1009914

DOI=10.3389/fneur.2022.1009914

ISSN=1664-2295

ABSTRACT=Background and purpose: Treatment of blood blister-like aneurysms (BBAs) has been a significant challenge mainly due to its high recurrence rate even after stent-assisted coiling (SAC) embolization. This study aims to evaluate the safety and efficacy of treating recurrent BBAs after SAC with flow diverter (FD). 
Methods: A retrospective series of patients with recurrent BBAs who got the retreatment of the FD from June 2018 to December 2021 was included to analyze perioperative safety, immediate postoperative and follow-up outcomes.
Results: The study enrolled 13 patients with recurrent BBAs, previously treated with SAC. Within previous stents, FD was deployed for retreatment, including 8 Tubridge FDs and 5 PEDs. The time interval between initial treatment and FD implantation was 14-90 days. Eleven cases were treated with single FD alone; 2 cases were treated with further endosaccular coiling embolization followed by FD implantation. Angiographic follow-up (6-12 months) was available in 12 patients, and all 12 recurrent BBAs were completely occluded. No perioperative complication was detected, and no rebleeding was found during clinical follow-up (6-36months). 
Conclusion: The use of FD to manage recurrent BBAs after SAC is technically feasible, safe, and effective. The key to the success of the procedure is to ensure that the FD stent is fully open and has good apposition with the previously implanted stent.