Article
作者: Spiotta, Alejandro M ; Lylyk, Pedro ; Helal, Ahmed ; Kan, Peter ; Levy, Elad I ; Tanweer, Omar ; Burkhardt, Jan Karl ; Salih, Mira ; Gajjar, Avi A ; Sioutas, Georgios ; Park, Min S ; Hanel, Ricardo ; Levine, Alex ; Brinjikji, Waleed ; Srinivasan, Visish M ; Heiferman, Daniel M ; Salem, Mohamed M ; Levitt, Michael R ; Monteiro, Andre ; Saber, Hamidreza ; Hassan, Ameer E ; Tjoumakaris, Stavropoula I ; Albuquerque, Felipe C ; Jabbour, Pascal ; Starke, Robert M ; Wolfe, Stacey Q ; Colby, Geoffrey P ; Abbas, Rawad ; Lylyk, Ivan ; Limbucci, Nicola ; El Naamani, Kareem ; Abdelsalam, Ahmed ; Desai, Sohum ; Lanzino, Giuseppe ; Riina, Howard ; Kim, Louis J ; Renieri, Leonardo ; Catapano, Joshua S ; Raz, Eytan ; Ares, William J ; Jankowitz, Brian ; Arthur, Adam S ; Thomas, Ajith J ; Siddiqui, Adnan H ; Ogilvy, Christopher S ; Lopes, Demetrius Klee ; Ducruet, Andrew F ; Dumont, Aaron S ; Borg, Nicholas ; Nelson, Peter Kim ; Shapiro, Maskim
Background:Flow-diverter stents (FDS) have become the standard of care for a wide range of intracranial aneurysms, but their efficacy/safety in the context of recurrent/recanalized aneurysms following stent-assisted coiling (SAC) is not well established. We evaluate the outcomes of FDS retreatment in a large multicenter cohort.
Methods:We retrospectively analyzed data from 118 patients across 22 institutions who underwent FDS retreatment for recurrent/persistent aneurysms after SAC (2008–22). The primary outcome was angiographic occlusion status at last follow-up, categorized as complete (100%), near-complete (90–99%), or incomplete (<90%) occlusion. Secondary outcomes included procedural complications and clinical outcomes measured by the modified Rankin Scale (mRS).
Results:A total of 118 patients (median age 57, 74.6% female) with median follow-up of 15.3 months were identified. Complete occlusion was achieved in 62.5% and near-complete occlusion in 25%. FDS deployment within the pre-existing stent was successful in 98.3% of cases. Major complications occurred in 3.4% of cases, including postoperative aneurysmal rupture with resultant mortality (1.6%) and thromboembolic events with long-term disability (1.6%). Favorable clinical outcomes (mRS 0–2) were observed in 95.1% of patients. Wider aneurysm neck diameter was a significant predictor of incomplete occlusion (adjusted OR (aOR) 1.23 per mm, P=0.044), with male sex trending towards association with non-occlusion (aOR 3.2, P=0.07), while baseline hypertension was associated with complete occlusion (aOR 0.32, P=0.048).
Conclusions:FDS treatment for recurrent/residual aneurysms after SAC represents a viable treatment option for these challenging cases with acceptable safety and reasonable occlusion rates, although lower than de novo FDS occlusion rates.