{
  "abstract": "Background Blood blister-like aneurysms (BBAs) of the internal carotid artery are rare but high risk lesions that frequently re-rupture due to their fragile structure and dissecting pathology. Treatment is particularly challenging in ruptured cases, given the risks associated with dual antiplatelet therapy. Recent advancements in flow diverter stents (FDSs) with surface modifications, and the use of single antiplatelet therapy (SAPT), offer a potential alternative strategy.Methods We conducted a retrospective review of 17 patients with ruptured internal carotid artery BBAs treated with surface modified FDS under SAPT (ticagrelor or prasugrel) bridged periprocedurally with intravenous tirofiban. All procedures were performed within the acute phase of subarachnoid hemorrhage. Clinical, radiographic outcomes, and procedure related complications were evaluated.Results Among 17 patients, 94.1% achieved complete angiographic occlusion, and 76.5% attained favorable clinical outcomes (modified Rankin Scale score ≤2). No aneurysm rebleeding or device related ischemic events occurred. A total of 11 patients underwent external ventricular drainage or ventriculoperitoneal shunting without discontinuing SAPT, and no hemorrhagic complications were observed. A literature review incorporating seven additional series identified a total of 42 FDS plus SAPT treated BBA cases, with similar safety and efficacy profiles.Conclusions Surface modified FDS with SAPT and tirofiban bridging appears to be a promising treatment option for ruptured BBAs, offering high occlusion rates with minimal thromboembolic and hemorrhagic complications. Larger prospective studies are needed to validate these findings.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgical Department, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan"
      ],
      "name": "Ching-Chang Chen"
    },
    {
      "affiliations": [
        "Neurosurgical Department, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan"
      ],
      "name": "Chun-Ting Chen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan"
      ],
      "name": "Mun-Chun Yeap"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan"
      ],
      "name": "Shuo-Chi Chien"
    },
    {
      "affiliations": [
        "Neurosurgical Department, New Taipei City Municipal Tucheng Hospital, New Taipei, Taiwan"
      ],
      "name": "Po-Chuan Hsieh"
    },
    {
      "affiliations": [
        "Radiology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan"
      ],
      "name": "Yi-Ming Wu"
    },
    {
      "affiliations": [
        "Neurosurgical Department, Tri-Service General Hospital, Taipei City, Taiwan"
      ],
      "name": "Kun‑Ting Hong"
    }
  ],
  "title": "Single antiplatelet therapy and tirofiban bridged with surface modified flow diverters for ruptured blood blister-like aneurysms: single center experience and systematic review",
  "uid": "92e75f24-144a-5d4f-8aeb-00627d226bb9"
}