Consecutive patients underwent SARIA with LDAC; aspirin 324 mg (4 baby aspirin) and clopidogrel 300 mg in 2 to 4 hours before procedure were enrolled from 2011 to 2022. Outcome was measured using modified Rankin Scale (mRS) score.

112 patients with mean age of 53 ± 13 underwent SARIA (7 ruptured and 55 symptomatic). Aneurysms are; Right internal carotid artery (ICA) 27, left ICA 35, middle cerebral artery 25, basilar artery 19 and anterior communicating artery 6. There are no intra-operative ruptures. Small left subarachnoid hemorrhage developed on a right MCA aneurysm on day 3, which resolved spontaneously. Stent thrombosis in one; resolved with intraarterial integrilin with no stroke.  Clinical TEE were observed in 2 cases (1.8%); first event was in a 42 years old woman with a giant right ICA giant aneurysm and achieved mRS 1. Second event was visual distortion and diplopia in a 66 years old woman with basilar artery aneurysm and achieved mRS1. Ruptured and symptomatic were repaired and no subarachnoid hemorrhages during follow-up.   Immediate complete and near complete obliteration of aneurysm was observed in 72% and subtotal in 28%. There was no mortality or permanent disability in our series. 90 days mRankins 0 and 1 was observed in 98 (92.5%), mRS 2 in 7(6.6%) at baseline and mRS 3 in 2 (1.9%), which sustained in 12 months.  

LDAC in SARIA is associated with reduced TEE without increased IH and good outcome. LDAP may be an option in SARIA to prevent TEE. Further studies are required.