Desai, Sohum

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.

Introduction Dual antiplatelet therapy has long been established as the preferred treatment option for patients with intracranial or extracranial stenting. Anticoagulation is the preferred treatment option for patients at high risk of stroke with embolic risk factors. There is no data currently available analyzing patients presenting with acute ischemic stroke on anticoagulation who require an intracranial and or extracranial stent (IC/EC), requiring DAPT and anticoagulation with mechanical thrombectomy. Our objective is toinvestigate differences in recanalization and outcomes as well as safety of DAPT and AC in the setting of AIS post MT with stenting when compared to patients without AC. Methods A retrospective search at a large comprehensive stroke center was conducted and data was analyzed from 2013 to 2022. Patients presenting with AIS on AC who had MT and required IC/EC stent were selected and compared to patients not on AC. Outcomes were measured as symptomatic ICH and mortality. Patient demographics, stroke risk factors and stroke severity were abstracted amongst other variables. Results There were 301 patients out of 917 (42.9% Female) who presented with anticoagulation use prior to mechanical thrombectomy requiring ic/ec stent placement and DAPT therapy. See Table 1 for baseline demographics. Symptomatic ICH was seen in 24 (7.9%) compared to 50 (8.1%), Odds ratio 0.86/ p‐value = 0.573, Mortality was seen in 51 (16.9%) patients who received DAPT and a/c compared to 129 (20.9%) (OR 0.67) p = 0.028. Logistic regression model did not show any significant difference (See Table 2). Conclusions There was no statistical difference in symptomatic ICH in acute ischemic stroke patients treated with mechanical thrombectomy and acute stenting on anticoagulation when compared to those without anticoagulation. There was statistical difference in mortality and DAPT/AC actually had lower mortality rates. This data suggests that performing intracranial and extracranial stenting in the acute stroke setting while on anticoagulation and adding DAPT is safe. A larger multicenter study with longer follow up is needed to further confirm these findings.