A176 The fragility paradox: flow diversion in the face of rupture

<h3>Introduction</h3> Acutely ruptured non-saccular aneurysms—including blister-like and dissecting variants—pose one of the most formidable challenges in neurointervention. Their fragile walls and ill-defined morphology render conventional clipping or coiling high-risk or unfeasible. Flow diverters offer a reconstructive alternative, but their use in the acute setting raises critical concerns related to antiplatelet therapy, procedural timing, and the need for external ventricular drainage (EVD). <h3>Aim of study</h3> To evaluate outcomes and strategic considerations in the use of flow diverters for acutely ruptured non-saccular aneurysms, with a focus on timing relative to EVD and tailored antiaggregation. <h3>Method</h3> We retrospectively reviewed patients presenting with subarachnoid haemorrhage from dissecting or blister aneurysms treated acutely with flow diverters. EVD was placed prior to any antiplatelet loading. Dual antiplatelet therapy (DAPT) was initiated intravenously in all cases 6–12 hours post EVD. Treatment included single or overlapping flow diverters, with or without adjunctive coiling, depending on morphology and rupture dynamics. <h3>Results</h3> All aneurysms were successfully treated without intraprocedural rupture. EVD-related haemorrhage was not observed in patients with pre-treatment drain placement. Most patients had favourable early clinical outcomes. <h3>Conclusion</h3> Flow diversion in the acute phase of non-saccular aneurysm rupture is feasible and effective when approached with meticulous timing. Pre-emptive drainage and adaptable antiplatelet strategies are key to navigating the paradox of treating fragile lesions with a device that requires thrombogenic control. <h3>Conflict of Interest</h3> No