In the setting of a ruptured aneurysm, the main goal is to secure the aneurysm to prevent re-bleeding, in the majority of cases it can be done with simple coiling assisted or not with balloon. Facing challenging ones, such as small aneurysms, tortuous anatomy, and high- risk bleeding aneurysms morphology, which increases the intraoperative rupture risk, other techniques should be considered. For this reason is essential to know the estimated risk of complications to decide which strategy would benefit the patient in an acute setting, also considering the skills of the operator. 
Coiling or Balloon-assisted coiling
Of note, when using a stent in the acute setting, the operator must have familiarity and knowledge with IV anti-platelet therapy to prevent stent occlusion and thromboembolic complications.
Another consideration when deciding on a flow diverter stent, depending on which device you chose, is a heavier catheter system to support stent deployment, increasing the procedure complexity.
P.S: watch the video for a very rich decision-making discussion with the experts, also an amazing discussion about IV antiplatelet use in the acute setting.
In conclusion, when dealing with an anterior cerebral artery aneurysm, mainly located in the Acom, there isn’t a treatment that fits all. We should always choose the strategy regarding cerebral artery and aneurysm anatomy, also the experience of the neuro- interventionalist performing different techniques.
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