Early recurrence of ruptured distal anterior cerebral artery aneurysm following stent-assisted coiling and salvage treatment with flow diverter: a case report and mechanistic analysis.

This article reports a novel case of a ruptured distal anterior cerebral artery (DACA) aneurysm. Initial laser-cut stent-assisted coiling resulted in significant recurrence at 1 month follow-up. Salvage treatment was then successfully performed with a flow diverter (FD) telescopically deployed within the original stent. One month follow-up angiography showed complete aneurysm obligation, classified as O'Kelly-Marotta (OKM) grade D, with unobstructed parent artery and branches. We also explored the possible mechanisms of recurrence and treatment strategies. To the best of our knowledge, this is the first reported case of successfully retreating a recurrent ruptured DACA aneurysm from a less than 2 mm parent artery using FD telescoping after failed stent-assisted coiling.