Introduction Herein, we present our results of flow diversion at MCA bifurcation reporting complications, occlusion rates and lessons learnt over course of 5-year period.

Methods MCA bifurcation aneurysms treated by flow diversion were included. Data was collected retrospectively about patient demographics, aneurysm characteristics, previous treatments and follow-up findings. Outcomes assessed included angiographic occlusion, fate of jailed branches and procedural complications.

Results 33 patients (21 female) with 34 aneurysms were treated. Approximately third of cases represented re-treatment. Adjunctive coiling was performed in 4 cases. Stent deployment was technically uncomplicated in 95% of cases (2 cases needed use of another stent).

All patients had at least 24 months surveillance with near or complete occlusion demonstrated in 87% of patients (30 aneurysms). In 3 patients, RR3 residuum was noted with no discernible change evident in another patient. Of the 27 completely occluded lesions, almost two-third displayed early occlusion. There was no significant correlation with occlusion of jailed branches (9%).

Whilst ischemic complications occurred in 25% (8 cases), majority (7) were reversible. Of these, 5 involved basal ganglia infarcts with considerable proportion symptomatic after DAPT cessation at 3 months. 3 cases involved ischemia within jailed M2 territory but had predisposing technical factors (overlapping FD stents and carotid stenosis).

Conclusion Flow diversion for MCA bifurcation aneurysms is feasible for challenging carefully selected lesions. Ischemic complications, however, are not negligible. Jailing of M2 branches was not associated with significant post-procedural ischaemic burden with majority of ischemic sequelae relating to lenticulostriate perforator infarcts after DAPT cessation.

Disclosure of Interest Nothing to disclose