O-057 Salvage Flow Diversion for Persistent/recanalized Aneurysms after Stent-Assisted Coiling: Multicenter Experience

Introduction There is limited literature regarding the safety and efficacy of salvage flow diversion (FD) in persistent/recanalized aneurysms after stent-assisted coiling (SAC) which can occur in 15–20% of cases, with preliminary data suggesting lower efficacy in this particular subgroup. Therefore, we sought to study this in a large multicenter cohort. Methods A series of consecutive patients undergoing salvage FD for failed SAC from 16 institutions were included (2011–2021) were included, with a primary outcome of angiographic occlusion and secondary outcomes of safety and complications. Results Eighty-two patients (median-age 57, 69.5% females) were included. The majority of aneurysms were located in the internal carotid artery (70.7%%), saccular in morphology (81.7%), with a median maximal diameter of 9 mm (IQR 5.6–15), and 51.2% initially presenting as ruptured aneurysms. The median elapsed time between initial SAC and salvage FD was 25.1 months, with Pipeline Embolization Device (PED) being the most commonly utilized FD device (95.1%). At a median follow-up of 19 months after FD, complete angiographic occlusion was achieved in 64.7% of cases, and near-complete occlusion (90–99%) in 17.6% of the cases. Permanent thromboembolic complications were encountered in 2.4% of the patients, and one procedural mortality secondary to hemorrhagic complication (1.2%). A favorable modified Rankin Scale (mRS) of 0–2 was encountered in 94.4% of patients on the last available clinical follow-up. Conclusions In our data, salvage flow diversion for persistent/recanalized aneurysms after SAC was associated with reasonable safety and efficacy profiles, comparable to de-novo flow-diverted aneurysms. Disclosures M. Salem: None. K. Naamani: None. A. Levine: None. V. Srinivasan: None. A. Baig: None. R. Abbas: None. S. Desai: None. J. Burks: None. V. Sinai: None. H. Saber: None. N. Borg: None. S. Al Kasab: None. K. Fargen: None. G. Lanzino: None. O. Tanweer: None. A. Spiotta: None. M. Shapiro: None. P. Kan: None. S. Tjoumakaris: None. L. Kim: None. M. Levitt: None. A. Hassan: None. S. Wolfe: None. F. Albuquerque: None. G. Colby: None. C. Ogilvy: None. A. Thomas: None. E. Levy: None. P. Nelson: None. A. Siddiqui: None. H. Riina: None. R. Starke: None. P. Jabbour: None. B. Jankowitz: None. J. Burkhardt: None.