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O-017 Repeat flow diversion for previously failed flow diversion: multicenter experience
  1. M Salem1,
  2. A Sweid2,
  3. A Kuhn3,
  4. A Dmytriw4,
  5. S Gomez-Paz1,
  6. G Maragkos1,
  7. M Waqas5,
  8. C Parra-Farinas6,
  9. A Salehani7,
  10. N Adeeb8,
  11. P Brouwer9,
  12. G Pickett10,
  13. M Ghuman11,
  14. V Yang11,
  15. A Weill12,
  16. C Cognard13,
  17. L Renieri14,
  18. P Kan15,
  19. N Limbucci14,
  20. V Mendes Pereira4,
  21. M Harrigan7,
  22. A Puri3,
  23. E Levy5,
  24. J Moore1,
  25. C Ogilvy1,
  26. T Marotta4,
  27. P Jabbour2,
  28. A Thomas1
  1. 1Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA
  2. 2Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA
  3. 3Neuroradiology, University of Massachusetts Medical Center, Worcester, MA
  4. 4Neuroradiology, Toronto Western Hospital, Toronto, ON, CANADA
  5. 5Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
  6. 6Neurosurgery, St. Michael’s Hospital, Ontario, Canada, Toronto, ON
  7. 7Neurosurgery, University of Alabama at Birmingham, Birmingham, AL
  8. 8Neurosurgery, Ochsner-Louisiana State University Hospital, Shreveport, LA
  9. 9Neurosurgery, Karolinska Universitetssjukhuset, Stockholm, Stockholm, SWEDEN
  10. 10Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada, Halifax, NS, CANADA
  11. 11Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Canada, Toronto, ON, CANADA
  12. 12Neurosurgery, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada, Montréal, QC, CANADA
  13. 13Neurosurgery, University Hospital of Toulouse, Toulouse, France, Toulouse, FRANCE
  14. 14Neuroradiology, Department of Interventional Neuroradiology, University of Florence, Florence, Italy, Florence, ITALY
  15. 15Neurosurgery, Baylor College of Medicine, Houston, Texas, Houston, TX


Background Aneurysmal persistence after flow-diversion (FD) occurs in 5–25% of aneurysms which might necessitate further treatment. A frequently used retreatment paradigm utilizes the deployment of another flow-diverting device (FDD) in a telescoping fashion within the existing device. There are no current data evaluating this strategy.

Methods A retrospective review of patients undergoing FD retreatment from 15 centers was performed, with inclusion criteria being repeat FD occurring for the same aneurysm at least 6 months after initial treatment, with minimum of 6 months of imaging follow-up after retreatment. Primary outcome was aneurysmal occlusion, and secondary outcomes were safety and complications. A multivariable logistic regression model was constructed to identify predictors of persistence/occlusion after retreatment. Comparative Kaplan-Meier curves were developed to assess the effect of early (6–12 months since initial treatment) vs late retreatment (>12 months since initial treatment) on the cumulative incidence of aneurysm occlusion over time.

Results Ninety-five patients (median age 57, 81% females) harboring 95 aneurysms underwent 198 treatment procedures. In our cohort, 87.4% of aneurysms were unruptured; 74.7% were saccular and 79% were located in the internal carotid artery (median maximal diameter 9-mm), with 87 patients treated twice and 8 patients treated thrice. Median elapsed-time between first and second treatment was 12.2 months. Last available follow-up was performed at median of 12.8 months after retreatment, and median of 30.6 months after initial treatment, showing complete occlusion in 46.2%, and near-complete occlusion (90–99%) in 20.4% of aneurysms. No difference in ischemic complications following initial treatment and retreatment (4.2% vs 4.2; p>0.99). On multivariable logistic regression, fusiform morphology was associated with higher odds of non-occlusion after retreatment (OR 7.2; p=0.003), with history of hypertension and incorporated branch into aneurysms trending toward incomplete occlusion (p=0.055 and p=0.054; respectively). Family history of aneurysms and positive smoking history were associated with higher odds of complete occlusion (p=0.019 and p=0.026; respectively). Kaplan-Meier curves comparative estimators showed no significant difference in time-to-occlusion between the two groups (log rank test, p=0.48).

Abstract O-017 Table 1

Conclusion Repeat flow diversion for persistent aneurysms is safe and effective. Fusiform morphology is the strongest predictor of aneurysmal persistence after repeat flow diversion.

Disclosures M. Salem: None. A. Sweid: None. A. Kuhn: None. A. Dmytriw: None. S. Gomez-Paz: None. G. Maragkos: None. M. Waqas: None. C. Parra-Farinas: None. A. Salehani: None. N. Adeeb: None. P. Brouwer: None. G. Pickett: None. M. Ghuman: None. V. Yang: None. A. Weill: None. C. Cognard: None. L. Renieri: None. P. Kan: None. N. Limbucci: None. V. Mendes Pereira: None. M. Harrigan: None. A. Puri: None. E. Levy: None. J. Moore: None. C. Ogilvy: None. T. Marotta: None. P. Jabbour: None. A. Thomas: None.

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