Introduction Evidence about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACAs) -beyond the anterior communicating artery (AComA)- aneurysms is very poor.

Aim of Study We present the largest multicentric analysis evaluating the outcomes of flow diverters in unruptured DACAs aneurysm treatment.

Methods Databases from 37 centers were retrospectively reviewed for unruptured DACAs aneurysms treated with flow diverters. Demographics, clinical presentation, radiographic characteristics, procedural complications, and outcomes were assessed. The occlusion of the aneurysm was assessed using the O’Kelly-Marotta (OKM) scale.

Results A total of 168 patients with an unruptured DACAs aneurysm were treated between January 2018 and December 2022. One hundred twenty-five were women (74.4%) and median age was 61 (IQR 52-67) years. The most common morphology was saccular (88.7%), with a branch involvement in 61,9% of cases. Median vessel diameter was 1.9 mm, and the FD was successfully deployed in 99,4 of cases. 96,4% required a single FD, while in 3,6% of cases 2 FDs were implanted. Median imaging follow-up was 16,5 (IQR 7-24) months. At last follow-up the rate of occlusion (OKM C+D,) was 82.1%. Symptomatic thrombo-embolic or hemorrhagic complications occurred in 5.3%. The rate of retreatment was 1,2%. Mortality 0.6%.

Conclusion Our study findings indicate that flow diverters represent a beneficial treatment option for DACAs aneurysms. Follow-up assessments revealed favorable aneurysm occlusion rates alongside a favorable safety profile.

Disclosure of Interest no.