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. 2020 Aug 27;33(6):451–464. doi: 10.1177/1971400920953299

Table 1.

Clinical data of the patients with delayed aneurysmal rupture after flow diverter treatment.

No. First author/year Age/sex Presenting symptom Aneurysm characteristics
 Antithrombotic regimen Intraoperative details
 Immediate flow alteration Immediate post-procedural complication Partial formation of thrombus after FD Interval to rupture Findings after rupture Further treatment Speculated mechanism of rupture Autopsy and finding Outcome (mRS)
Ruptured or unruptured Location Morphology Intra-aneurysmal thrombosis Size (mm) Type and number of FDs Coils assisting
1 Byrne/201011 NA/NM NA/NM Unruptured MCA Fusiform NA/NM 24 Clopidogrel and aspirin before and after treatment, heparin during treatment, warfarin and aspirin after ceasing clopidogrel Silk No NA/NM No Yes Six months Acute hemorrhage, aneurysm enlargement Surgical bypass Warfarin NA/NM Death
2 Mustafa/201012 39/F Hemifacial pain Unruptured ICA–cavernous Fusiform No 17.6 300 mg Plavix before treatment, Plavix and aspirin after treatment One Silk (4 mm×35 mm) No Significant stagnation of contrast within aneurysm No Yes Two weeks CCF TVE of CCF with coils Unknown NA/NM 0
3 Lubicz/201013 71/F Bitemporal hemianopsia Unruptured ICA–ophthalmic Saccular No 28 Systemic heparinization for 24 h. Aspirin and clopidogrel before treatment and continued for 3–6 months (aspirin 160 mg/day, clopidogrel 75 mg/day) One Silk (4 mm×30 mm) No Significant flow reduction No NA/NM 13 days Massive SAH, stent migration NA/NM Migration into sac NA/NM Death
4 Turowski/201114 69/F Incidental Unruptured ICA–ophthalmic Saccular No 18.2 Aspirin 100 mg/day and clopidogrel 75 mg/day for five days before treatment, and the same regimen after treatment One Silk (4mm×30 mm) No Significant contrast stasis No Yes 20 days Extensive SAH NA/NM Unknown NA/NM Death
5 Kulcsár/201115 50/M Acute severe headache Unruptured ICA–supraclinoid Saccular Yes 21 Aspirin and clopidogrel before treatment and continue for 2–3 months after FD placement One Silk Yes Stagnation of contrast within aneurysm Thromboembolism Yes Two days SAH and ICH NA/NM Unknown NA/NM Good recovery
6 74/F Incidental Unruptured ICA–cavernous Saccular NA/NM 20 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement One Silk No Stagnation of contrast within aneurysm No Yes Three days CCF PAO Unknown NA/NM NA/NM
7 44/F Incidental Unruptured ICA–ophthalmic Saccular No 18 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement One Silk No Inertia-driven inflow jet, stagnation of contrast within aneurysm No Yes Five days Diffuse SAH NA/NM Unknown NA/NM Death
8 45/F Visual loss Unruptured ICA–ophthalmic Fusiform NA/NM 20 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement One Silk No Stagnation of contrast within aneurysm No Yes Five days Diffuse SAH NA/NM Unknown NA/NM Death
9 70/M Bilateral visual deficit Unruptured ICA–supraclinoid Fusiform No 34 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement Two Leo, one Silk No Persisting inflow jet, stagnation of contrast within aneurysm Thromboembolism Yes 12 days Diffuse SAH NA/NM Unknown Mural thinning and necrosis, loss of fibrous tissue and medial smooth muscle Death
10 54/M Visual problems Unruptured Basilar trunk Fusiform No 17 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement One Leo, two Silk No Significant contrast stasis No Yes 18 days Diffuse SAH NA/NM Unknown Mural thinning and necrosis, loss of fibrous tissue and medial smooth muscle Death
11 69/F Acute severe headache Unruptured ICA–ophthalmic Saccular NA/NM 15 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement One Silk No Stagnation of contrast within aneurysm Thromboembolism Yes 20 days Diffuse SAH NA/NM Unknown NA/NM Death
12 69/M Diplopia, headache, unsteadiness Unruptured Basilar trunk Fusiform NA/NM 25 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement One Leo, two Silk No Stagnation of contrast within aneurysm No Yes 28 days Diffuse SAH NA/NM Unknown NA/NM Death
13 49/F Visual deficit Unruptured ICA–supraclinoid Saccular NA/NM 25 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement One Silk No Stagnation of contrast within aneurysm No Yes 48 days Diffuse SAH NA/NM Unknown NA/NM Death
14 48/F Diplopia Unruptured ICA–cavernous Saccular NA/NM 24 Aspirin and clopidogrel before treatment and continue for 2-3 months after FD placement, aspirin till rupture One Silk No Stagnation of contrast within aneurysm No Yes 110 days CCF PAO Unknown NA/NM NA/NM
15 66/F Visual deficit Unruptured ICA–supraclinoid Saccular NA/NM 18 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement, aspirin until rupture One Silk No Stagnation of contrast within aneurysm Thromboembolism Yes 135 days Diffuse SAH NA/NM Unknown NA/NM Severe disability
16 67/F Brainstem symptom Unruptured Basilar trunk Fusiform NA/NM 31 Aspirin and clopidogrel before treatment and continued for 2–3 months after FD placement, aspirin until rupture One Leo, one Silk No Stagnation of contrast within aneurysm No Yes 150 days Diffuse SAH NA/NM Unknown NA/NM Death
17 Cebral/201116 62/F NA/NM Unruptured ICA–supraclinoid Saccular No 26 NA/NM One Pipeline No Significant contrast stasis NA/NM NA/NM Four days NA/NM NA/NM Unknown NA/NM NA/NM
18 60/F NA/NM Unruptured ICA–ophthalmic Saccular No 38 NA/NM Two Pipeline No Significant contrast stasis NA/NM NA/NM Seven days NA/NM NA/NM Unknown NA/NM NA/NM
19 Chow/201217 NA/NM/F Impairment of ambulation and swallowing Unruptured VA Saccular No 23 Aspirin and clopidogrel before and after treatment, heparin during procedure One Pipeline (4mm×20 mm) No Significant contrast stasis No Yes 20 days SAH and ICH NA/NM Unknown Mural necrosis Death
20 Kan/201218 50/F Vision loss Unruptured ICA–ophthalmic Saccular No 22.46 Aspirin (325 mg/day) and clopidogrel (75 mg/day) before treatment, aspirin and clopidogrel after treatment Three Pipeline (4mm×18mm, 4.25mm×16mm, 4.25mm×14 mm) No Significant contrast stasis No NA/NM Six days SAH and ICH NA/NM Unknown NA/NM Death
21 Cirillo/2012 19 NA/NM/M NA/NM Unruptured Basilar artery Saccular No >25 Ticlopidine (twice/day) and aspirin (300 mg/day) for before (four days) and after treatment, heparin and aspirin during procedure One Silk (5.5mm×60 mm) No Significant contrast stasis Acute hydrocephalus Yes One week ICH and IVH NA/NM Unknown NA/NM Death
22 Siddiqui/201220 42/M Hemiparesis, facial weakness Unruptured Basilar artery Fusiform No 35.6 Aspirin and clopidogrel before treatment, heparin during procedure, eptifibatide after treatment Three Pipeline (4 mm× 20mm, 4 mm× 12mm, 3.75mm ×12 mm) No Intra-aneurysmal flow is evident Dysarthria, hemiparesis NA/NM One day SAH and brainstem hemorrhage NA/NM Unknown NA/NM Death
23 42/F Vertigo, ataxia Unruptured Basilar artery Fusiform No 37.1 Aspirin and clopidogrel before treatment, eptifibatide after treatment Three Pipeline (4 mm× 18mm, 4 mm× 12mm, 3.75mm ×16 mm) Yes Significant contrast stasis Hemiparesis Yes Nine weeks Diffuse SAH NA/NM Unknown NA/NM Death
24 Velioglu/201221 37/F NA/NM Unruptured ICA terminus Saccular No 23 Aspirin (100–300 mg/day) and clopidogrel (75 mg/day) before and after treatment, heparin during procedure Leo, Silk Yes Slow flow in sac Hemiparesis Yes Three days SAH and diffuse brain edema NA/NM Unknown NA/NM Death
25 47/F CN III palsy Unruptured ICA–ophthalmic Saccular No 20 Aspirin (100–300 mg/day) and clopidogrel (75 mg/day) before and after treatment, heparin during procedure Silk No Slow flow in sac No Yes Five days SAH and diffuse brain edema NA/NM Unknown NA/NM Death
26 40/F Mass effect Unruptured ICA–ophthalmic Saccular No 18 Aspirin (100–300 mg/day) and clopidogrel (75 mg/day) before and after treatment, heparin during procedure Silk, Leo No Significant slow flow in sac Intra-stent thrombosis Yes Five days SAH and infarction One additional Silk Unknown NA/NM 2
27 35/M CN III palsy Unruptured ICA–supraclinoid Fusiform No 50 Aspirin (100–300 mg/day) and clopidogrel (75 mg/day) before and after treatment, heparin during procedure Three Leo, two Silk No Slow flow in sac No Yes 30 days ICH and IVH NA/NM Unknown NA/NM Death
28 40/F Headache and ophthalmic symptoms Unruptured ICA–ophthalmic Saccular No 50 Aspirin (100–300 mg/day) and clopidogrel (75 mg/day) before and after treatment, heparin during procedure Silk No Significant slow flow in sac No NA/NM 25 days SAH NA/NM Unknown NA/NM Death
29 McAuliffe/201222 56/F SAH Ruptured ICA–superior hypophyseal Saccular No 21 Loading dose aspirin (300 mg) and clopidogrel (600 mg) before treatment, heparin during procedure, aspirin and clopidogrel after treatment Three Pipeline No Significant contrast stasis without discernible inflow jet No Yes Eight days SAH, aneurysm refilling with a new rupture point locule One additional Pipeline Unknown NA/NM Death
30 Colby/201323 NA/NM NA/NM Unruptured ICA–ophthalmic Saccular No 3 Aspirin (325 mg/day) and clopidogrel (75 mg/day) for seven days before treatment, heparin during procedure One Pipeline (4mm×16 mm) No Persistent filling of contrast No No 5 h Diffuse SAH NA/NM Unknown SAH from the aneurysm Death
31 Darsaut et al./201324 69/F Paraesthesias, hemiparesis Unruptured ICA–cavernous Saccular No 60 Aspirin (325 mg/day) and clopidogrel (75 mg/day) for seven days before treatment, aspirin and clopidogrel after treatment Two Silk No Significant contrast stasis Dysphasia, hemiparesis Yes One day ICH NA/NM Unknown Neutrophils infiltration Death
32 Chalouhi/201325 46/F Homonymous hemianopsia Unruptured ICA–supraclinoid Saccular No 28 Aspirin and clopidogrel before treatment One Pipeline (4.25mm×30 mm) No Significant contrast stasis Pipeline migration into sac Yes Three days Extensive SAH, stent migration Ventriculostomy, PAO with coils and Onyx Pipeline migration into sac NA/NM Death
33 Toma/201326 60/F Brainstem compression Unruptured VA Saccular No 25 Aspirin and clopidogrel before (300 mg/day) and after (75 mg/day) treatment, heparin for 5 days after treatment Three Pipeline No Significant contrast stasis No Yes One week Extensive SAH and IVH NA/NM Unknown NA/NM Death
34 42/F NA/NM Unruptured ICA–ophthalmic Saccular NA/NM 29 Aspirin and clopidogrel before (300 mg/day) and after (75 mg/day) treatment, heparin for five days after treatment NA/NM NA/NM Significant contrast stasis NA/NM Yes Four days NA/NM NA/NM Unknown NA/NM Death
35 38/F NA/NM Unruptured Basilar artery Saccular NA/NM 38 Aspirin and clopidogrel before (300 mg/day) and after (75 mg/day) treatment, heparin for five days after treatment NA/NM NA/NM Significant contrast stasis NA/NM Yes 20 days NA/NM NA/NM Unknown NA/NM Death
36 Kuzmik/201327 48/NA/NM Nausea and vomiting Unruptured ICA–paraclinoid Saccular No 19 Heparin for 48 h after treatment and then aspirin and clopidogrel Two Silk No Minimal residual neck filling No Yes One week Extensive SAH, partial recanalization of aneurysm NA/NM Unknown NA/NM Death
37 Piano/201328 66/F NA/NM Unruptured Basilar artery Saccular No >25 Aspirin and ticlopidine before (3–7 days) and after treatment Pipeline No Significant contrast stasis without discernible inflow jet No Yes Three weeks SAH NA/NM Unknown NA/NM Death
38 Cruz/201329 NM SAH Ruptured ICA–supraclinoid Saccular No >25 Aspirin (325 mg) and clopidogrel (600 mg) before treatment, heparin during procedure, aspirin and clopidogrel after treatment One Pipeline Yes Significant contrast stasis No NA/NM Within 24 h SAH NA/NM Unknown NA/NM Death
39 Chitale/2014 30 54/F Headache Unruptured ICA–paraclinoid Saccular Yes 5.5 NA/NM Pipeline No Significant contrast stasis No NA/NM Within 1 h Diffuse SAH Ventriculostomy Unknown NA/NM Death
40 Briganti/201531 41/F Visual loss, ophthalmoplegia Unruptured ICA–supraclinoid Saccular No 35 Aspirin (150 mg) and clopidogrel (75 mg) before (five days) treatment, heparin during procedure Two Pipeline Yes Significant contrast stasis No NA/NM 12 h Diffuse SAH NA/NM Unknown NA/NM Death
41 Ikeda/201532 67/F Decreased eye vision Unruptured ICA–supraclinoid, ICA–paraclinoid Saccular No 16 Aspirin (100 mg/day, 14 days), clopidogrel (75 mg/day, 14 days), and cilostazol (200 mg/day, two days) before and after treatment, heparin during procedure One Pipeline (3.75mm×18 mm) No Significant contrast stasis No Yes 34 days SAH No Unknown Macrophage infiltration and wall degeneration Death
42 Nerva/201533 30s/NA/NM Headache and confusion Ruptured ICA–supraclinoid BBA No 5 Loading dosage aspirin (325 mg) and clopidogrel (75 mg) before treatment, heparin during procedure One Pipeline No Contrast extravasation, without contrast stasis in the aneurysm No No Five days SAH and ICH One additional Pipeline Unknown NA/NM Death
43 Lin/201534 Middle-aged/NA/NM Headache and diplopia Unruptured ICA–cavernous Saccular No 10 Aspirin (325 mg/day) and clopidogrel (75 mg/day) for before (seven days) and after treatment One Pipeline (5mm×18 mm) No Significant contrast stasis without inflow jet No NA/NM Six weeks CCF TVE of the aneurysm sac and CS with coils Unknown NA/NM 0
44 Middle-aged/NA/NM CN III palsy Unruptured ICA–cavernous Saccular No 17 Aspirin (325 mg/day) and clopidogrel (75 mg/day) before (seven days) and after treatment One Pipeline (4.5mm×20 mm) No Significant contrast stasis No NA/NM Three days CCF TVE of the aneurysm sac and CS with coils Unknown NA/NM 0
45 Fox/201535 Elderly/M Gait ataxia, hyperflexia Unruptured Basilar artery Saccular NA/NM 27 Dual antiplatelets before and after treatment One Pipeline No Significant contrast stasis No Yes One week SAH NA/NM Unknown Organized thrombosis, linear tear Death
46 Mazur/201636 29/M Headache Ruptured ICA-supraclinoid BBA No 4.3 Abciximab during procedure, aspirin and clopidogrel after treatment One Pipeline (5mm×14 mm) No Without significant contrast stasis No Yes Nine days SAH and ICH One additional Pipeline Unknown NA/NM Death
47 Raychev/201637 Middle-aged/NA/NM Hemiparesis and CN III palsy Unruptured ICA–PcomA Saccular NA/NM >25 Aspirin (325 mg/day) and clopidogrel (75 mg/day) before treatment One Pipeline No Significant contrast stagnation No NA/NM Five months SAH and ICH Sacrifice of ICA Unknown NA/NM NA/NM
48 Roy/201738 NA/NM Incidental Unruptured ICA–cavernous Saccular NA/NM 17.4 NA/NM Pipeline NA/NM NA/NM NA/NM NA/NM 11 days CCF ICA sacrifice Unknown NA/NM 0
49 NA/NM Incidental Unruptured ICA–cavernous Saccular NA/NM 14.5 NA/NM Pipeline NA/NM NA/NM NA/NM NA/NM 11 days CCF ICA sacrifice Unknown NA/NM 1
50 NA/NM Incidental Unruptured ICA–cavernous Saccular NA/NM 31 NA/NM Pipeline NA/NM NA/NM NA/NM NA/NM Three days CCF ICA sacrifice Unknown NA/NM 0
51 Elderly patient/NA/NM CN IV palsy Unruptured ICA–cavernous Saccular No 19 Aspirin and clopidogrel before treatment One Pipeline No Significant contrast stasis No NA/NM Six days CCF ICA sacrifice Unknown NA/NM 1
52 Elderly patient/NA/NM CN III palsy Unruptured ICA–cavernous Saccular No 18.8 Aspirin and clopidogrel before treatment One Pipeline No Significant contrast stasis No NA/NM Six days CCF ICA sacrifice Unknown NA/NM 0
53 Oishi/201839 86/F CN III palsy Unruptured ICA–cavernous Saccular No 20 Aspirin 105 mg/day and clopidogrel 50 mg/day for before (10 days) and after treatment, heparin during procedure Three Pipeline (4.5mm×30mm, 4.75mm×30mm, 5mm×30 mm) No Significant contrast stasis No NA/NM Six weeks CCF TVE of the aneurysm sac and CS with coils Unknown NA/NM 0
54 Hampton/201840 NA/NM Headache, hemianopsia Unruptured ICA terminus Saccular No 35 Aspirin 75 mg/day and clopidogrel 75 mg/day for one week before treatment, heparin, aspirin and clopidogrel after treatment One Pipeline (2.75mm ×20 mm) No Significant contrast stasis No Yes Five days SAH and IVH NA/NM Unknown NA/NM Death
55 Sami/20188 Young/NA/NM NA/NM Unruptured ICA–cavernous Pseudoaneurysm No 6 Aspirin 325 mg/day and clopidogrel 75 mg/day before (one week) and after treatment, heparin during procedure One Pipeline No Significant contrast stasis No Yes One week CCF One additional Pipeline Unknown NA/NM 0
56 Nakae/201841 81/F Diplopia Unruptured ICA–cavernous Saccular No 18 Aspirin 100 mg/day and clopidogrel 75 mg/day before treatment, heparin during procedure One Pipeline (4.75 mm×25 mm) No Significant contrast stasis No NA/NM 10 days SAH, CCF TVE of the aneurysm sac and CS with coils Unknown NA/NM 1
57 Bhogal/201842 62/M Progressive cognitive decline Unruptured MCA bifurcation Dissecting Yes 28 Aspirin 100 mg/day and clopidogrel 75 mg/day before (one week) and after treatment, heparin during procedure One Pipeline at first admission, a second Pipeline six months later No Significant contrast stasis No Yes Eight months ICH Decompressive craniectomy Unknown NA/NM Death
58 Griessenauer/201943 69/F SAH Ruptured VA Dissecting NA/NM 8 Loading dose of aspirin (650 mg) and clopidogrel (600 mg) before treatment, heparin during procedure, aspirin and clopidogrel after treatment Pipeline NA/NM NA/NM NA/NM NA/NM The same day SAH NA/NM Unknown NA/NM Death
59 Piano/201944 70/M NA/NM Unruptured Basilar trunk Dissecting NA/NM > 25 Dual antiplatelet medication before and after treatment One FRED Yes NA/NM NA/NM NA/NM 35 days SAH NA/NM Unknown NA/NM Death
60 Sirakov/201945 NA/NM Mass effect Unruptured ICA–ophthalmic Saccular No > 25 Aspirin 100 mg/day and clopidogrel 75 mg/day before (≥3 days) and after treatment, heparin during procedure One p64 Yes Significant contrast stasis No NA/NM Nine days ICH Conservative Unknown NA/NM 3

BBA: blood blister aneurysm; CCF: carotid-cavernous fistula; CN: cranial nerve; CS: cavernous sinus; F: female; FD: flow diverter; ICA: internal carotid artery; ICH: intracerebral hemorrhage; IVH: intraventricular hemorrhage; M: male; MCA: middle cerebral artery; mRS: modified Rankin Scale; NA/NM: not applicable/not mentioned; PAO: parent artery occlusion; PcomA: posterior communicating artery; SAH: subarachnoid hemorrhage; TVE: transvenous embolization; VA: vertebral artery