Multicenter analysis of flow diversion for recurrent/persistent intracranial aneurysms after stent-assisted coiling

Authors

Mohamed M. Salem, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA jan.burkhardt@pennmedicine.upenn.edu msalem_123@yahoo.com.
Ahmed Helal, Advocate Health - Midwest
Avi A. Gajjar, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Georgios Sioutas, Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Demetrius Klee Lopes, Advocate Health - MidwestFollow
et al

Recommended Citation

Salem MM, Helal A, Gajjar AA, et al. Multicenter analysis of flow diversion for recurrent/persistent intracranial aneurysms after stent-assisted coiling. J Neurointerv Surg. Published online March 26, 2025. doi:10.1136/jnis-2024-022422

Abstract

Background:Flow-diverter stents (FDS) have become the standard of care for a wide range of intracranial aneurysms, but their efficacy/safety in the context of recurrent/recanalized aneurysms following stent-assisted coiling (SAC) is not well established. We evaluate the outcomes of FDS retreatment in a large multicenter cohort.

Methods:We retrospectively analyzed data from 118 patients across 22 institutions who underwent FDS retreatment for recurrent/persistent aneurysms after SAC (2008-22). The primary outcome was angiographic occlusion status at last follow-up, categorized as complete (100%), near-complete (90-99%), or incomplete (<90%) occlusion. Secondary outcomes included procedural complications and clinical outcomes measured by the modified Rankin Scale (mRS).

Results:A total of 118 patients (median age 57, 74.6% female) with median follow-up of 15.3 months were identified. Complete occlusion was achieved in 62.5% and near-complete occlusion in 25%. FDS deployment within the pre-existing stent was successful in 98.3% of cases. Major complications occurred in 3.4% of cases, including postoperative aneurysmal rupture with resultant mortality (1.6%) and thromboembolic events with long-term disability (1.6%). Favorable clinical outcomes (mRS 0-2) were observed in 95.1% of patients. Wider aneurysm neck diameter was a significant predictor of incomplete occlusion (adjusted OR (aOR) 1.23 per mm, P=0.044), with male sex trending towards association with non-occlusion (aOR 3.2, P=0.07), while baseline hypertension was associated with complete occlusion (aOR 0.32, P=0.048).

Conclusions:FDS treatment for recurrent/residual aneurysms after SAC represents a viable treatment option for these challenging cases with acceptable safety and reasonable occlusion rates, although lower than de novo FDS occlusion rates.

Document Type

Article

PubMed ID

40139781