Introduction In recent years, there has been a growing interest in using flow diverters (FD) to treat MCA aneurysms.

Aim of study In this study, we investigated the safety and effectiveness of new generation low profile flow diverters to treat middle cerebral artery (MCA) bifurcation aneurysms among all patients treated for intracranial aneurysms at our center.

Methods This was a single center, single-arm retrospective study of prospectively collected data of patients treated with p48 HPC, p64 HPC, Silk Vista Baby and PED Shield Vantage at our high-volume center between March 2018–March 2023. The primary efficacy endpoint was complete occlusion as measured by a class 1 Raymond-Roy score at 1-year and 2-year follow-up. The primary safety endpoint was major morbidity and neurological mortality up to 2 years following intervention.

Results A total of 75 patients (mean age 57.1±2.7 years; 83.9% female) with 75 saccular MCA aneurysms (mean size 4.6±3.2 mm) were treated with a low-profile FD. A total of 83 devices were deployed, with 94.6% (71/75) of aneurysms requiring only one device. Intraprocedural technical complications occurred in 5.3% (4/75), 2 shortening of the device requiring an additional FD, 1 in-stent thrombosis, 1 subarachnoid hemorrhage post-procedure. Follow-up angiography was available for 73.3% (55/75) of the patients at a mean time of 12.4 months. Complete occlusion was demonstrated for 56.0% of aneurysms at 6 months, 63.2% at 12 months and 81,9% at 24 months. The overall rates of major morbidity and neurological mortality after 2 years were 2.7% (2/75) and 0% respectively. 5.3% of jailed branches presented an asymptomatic narrowing, 5.3% an asymptomatic occlusion and 1.3% presented a symptomatic occlusion. Dual antiplatelet therapy was maintained with prasugrel 10mg/day and AAS 100mg/day 1 year following FD implantation then continued with AAS 100mg/day.

Conclusion Low profile new generation flow diverters combined with prolonged DAPT therapy with prasugrel demonstrated high rates of complete long-term occlusion, as well as low rates of mortality and morbidity consistent with fewer symptomatic jailed artery occlusions.

Disclosures I. Lylyk: None. P. Lylyk: None. J. Lundquist: None. C. Bleise: None. E. Scrivano: None. N. Perez: None. R. Nella Castro: None. P. Lylyk: None.