Multicenter analysis of flow diversion for recurrent/persistent intracranial aneurysms after stent-assisted coiling.

Authors

• Mohamed M Salem
• Ahmed Helal
• Avi A Gajjar
• Georgios Sioutas
• Kareem El Naamani
• Daniel M Heiferman
• Ivan Lylyk
• Alex Levine
• Leonardo Renieri
• Andre Monteiro
• Mira Salih
• Rawad Abbas
• Ahmed Abdelsalam
• Sohum Desai
• Hamidreza Saber
• Joshua S Catapano
• Nicholas Borg
• Giuseppe Lanzino
• Waleed Brinjikji
• Omar Tanweer
• Alejandro M Spiotta
• Min S Park
• Aaron S Dumont
• Adam S Arthur
• Louis J Kim
• Michael R Levitt
• Peter Kan
• Ameer E Hassan
• Nicola Limbucci
• Geoffrey P Colby
• Stacey Q Wolfe
• Eytan Raz
• Ricardo Hanel
• Maskim Shapiro
• Adnan H Siddiqui
• William J Ares
• Christopher S Ogilvy
• Elad I Levy
• Ajith J Thomas
• Visish M Srinivasan
• Robert M Starke
• Andrew F Ducruet
• Stavropoula I Tjoumakaris
• Brian Jankowitz
• Felipe C Albuquerque
• Peter Kim Nelson
• Howard Riina
• Pedro Lylyk
• Demetrius Klee Lopes
• Pascal Jabbour
• Jan Karl Burkhardt

Publication/Presentation Date

1-13-2026

Abstract

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.

Volume

18

Issue

2

First Page

324

Last Page

331

ISSN

1759-8486

Published In/Presented At

Salem, M. M., Helal, A., Gajjar, A. A., Sioutas, G., El Naamani, K., Heiferman, D. M., Lylyk, I., Levine, A., Renieri, L., Monteiro, A., Salih, M., Abbas, R., Abdelsalam, A., Desai, S., Saber, H., Catapano, J. S., Borg, N., Lanzino, G., Brinjikji, W., Tanweer, O., … Burkhardt, J. K. (2026). Multicenter analysis of flow diversion for recurrent/persistent intracranial aneurysms after stent-assisted coiling. Journal of neurointerventional surgery, 18(2), 324–331. https://doi.org/10.1136/jnis-2024-022422

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

40139781

Department(s)

Administration and Leadership

Document Type

Article