Abstract： 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.