{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:54:25Z","timestamp":1790927665872,"version":"4.1.0"},"reference-count":12,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Rep Neurol"],"abstract":"<jats:p>&lt;p&gt;Introduction: Flow diverters significantly alter the inflow dynamics of an aneurysm, leading to both qualitative and quantitative changes in the intra-aneurysmal hemodynamic environment (AJNR Am J Neuroradiol. 2014 Aug 1;35(8):1567\u201373). Case Presentation: A 65-year-old woman with a giant left internal carotid artery aneurysm causing visual symptoms underwent treatment with coiling, Surpass Evolve flow diverter placement, and balloon angioplasty. Despite being on dual antiplatelet therapy, she developed in-stent thrombosis on postoperative day 4, leading to neurological symptoms. Intra-arterial thrombolysis with eptifibatide and tenecteplase achieved near total recanalization and initial clinical improvement. However, she subsequently developed a massive subarachnoid hemorrhage and was declared brain dead the next day. Conclusion: Delayed rupture of an aneurysm following Surpass Evolve flow diverter embolization is a rare complication associated with high morbidity and mortality. In our case, in-stent thrombosis occurred on postoperative day 4 and subsequently progressed to aneurysmal rupture, despite the presence of coils within the aneurysm sac. Rupture on the fourth day after Surpass Evolve flow diverter placement \u2013 despite initial coil embolization \u2013 along with aneurysmal thrombosis, partial recanalization, thrombus extension into the parent vessel, and subsequent treatment with intra-arterial eptifibatide and tenecteplase highlights the profound hemodynamic instability in giant aneurysms that can contribute to post-procedural rupture. &lt;\/p&gt;<\/jats:p>","DOI":"10.1159\/000551600","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T16:01:18Z","timestamp":1786032078000},"page":"550-557","source":"Crossref","is-referenced-by-count":0,"title":["Delayed Aneurysmal Rupture following Flow Diverter Placement despite Adjunctive Coiling: Case Report"],"prefix":"10.1159","volume":"18","author":[{"given":"Mikael Aseged","family":"Shimekit","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Masresha","family":"Fetene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eskedar Kebede","family":"Belayneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleab","family":"Eticha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Yirgalem","family":"Teka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eden Enyew","family":"Zeleke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bisrat","family":"Germame","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meti","family":"Taye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariku","family":"Assefa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wondwossen G.","family":"Tekle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3913"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-015-1615-4"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A6256"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1177\/1971400915602803"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.21037\/atm-21-5939"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-012-1482-2"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.3390\/fluids7080254"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.01.079"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2018-014511.rep"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1007\/BF02684187"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2014-011325"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci12060810"}],"container-title":["Case Reports in Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000551600","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:17:50Z","timestamp":1790925470000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000551600"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000551600","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.33173135","asserted-by":"subject"}]},"ISSN":["1662-680X"],"issn-type":[{"value":"1662-680X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]}}}