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目的:探讨应用密网支架联合覆膜支架治疗颅内难治性动脉瘤的有效性及安全性。方法:回顾性分析2019年4月至2020年6月，在郑州大学第一附属医院神经介入科进行治疗的4例颅内难治性动脉瘤患者的手术及临床资料，男2例、女2例，年龄49~59岁，复发血泡样动脉瘤1例，大动脉瘤1例，巨大动脉瘤2例。手术中应用密网支架先跨越瘤颈植入载瘤动脉，然后于瘤颈口处、密网支架内再植入1枚覆膜支架。结果:4例手术均顺利实施，2例采用Pipeline+Willis支架，2例采用Tubridge+Willis支架，技术成功率100%，无围手术期并发症，术后即刻造影4例均显示良好的瘤颈口隔绝效果，大囊窄颈口的喷射征消失，动脉瘤未再显影。4例均获得影像学随访，平均随访时间6个月，其中DSA随访3例，头颈联合CTA随访1例，动脉瘤均获得治愈。结论:密网支架联合覆膜支架治疗颅内难治性动脉瘤安全、有效，对颈内动脉颅内段的大囊、窄颈合并瘤颈口喷射征以及血泡样等难治动脉瘤病例值得尝试应用。“,”Objective:To explore the safety and efficacy of flow diverter combined with drug-coated stent in the treatment of refractory intracranial aneurysms.Methods:Four patients (2 males and 2 females, aged 49-59 years old) with refractory intracranial aneurysm treated with Flow Diverter combined with drug-coated stent at the First Affiliated Hospital of Zhengzhou University from April 2019 to June 2020 were included. The surgical and clinical data were retrospectively reviewed. All 4 patients received surgical treatment. In 4 cases, there was one recurrent blood blister-like aneurysm, one large aneurysm, and two giant aneurysms. During the operation, Flow diverter was put in the parent artery across the neck of the aneurysm, and then a drug-coated stent was implanted at the neck of the aneurysm, within the Flow diverter.Results:The surgery was successfully performed for all 4 cases. Pipeline combined Willis stent were applied in 2 cases; Tubridge combined Willis stent were used in another 2 cases. The technical success rate was 100%, and there were no perioperative complications. The immediate follow-up angiography demonstrated occlusion of all aneurysmal neck. The jet sign disappeared in aneurysms with large sac and narrow neck. No signs of aneurysms displayed. Follow-up exams was performed with DSA in 3 cases and 1 with CTA, with the average follow-up time as 6 months. All four aneurysms were cured.Conclusions:The safety and efficacy of Flow diverter combined with the covered stent is verified for the treatment of refractory intracranial aneurysms. It is worthy of further investigation for application of this treatment method in refractory intracranial aneurysms with very large sac, narrow neck with jet sign, and blood blister-like aneurysm in the intracranial segment of the internal carotid artery.