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

Mohamed M Salem^{1

2}, Ahmed Helal², Avi A Gajjar^{3

4}, Georgios Sioutas³, Kareem El Naamani⁵, Daniel M Heiferman⁶, Ivan Lylyk⁷, Alex Levine⁸, Leonardo Renieri⁹, Andre Monteiro¹⁰, Mira Salih¹¹, Rawad Abbas⁵, Ahmed Abdelsalam¹², Sohum Desai¹³, Hamidreza Saber¹⁴, Joshua S Catapano³, Nicholas Borg^{15

16}, Giuseppe Lanzino¹⁵, Waleed Brinjikji¹⁵, Omar Tanweer¹⁷, Alejandro M Spiotta¹⁸, Min S Park¹⁹, Aaron S Dumont²⁰, Adam S Arthur²¹, Louis J Kim²², Michael R Levitt²², Peter Kan²³, Ameer E Hassan²⁴, Nicola Limbucci⁹, Geoffrey P Colby¹⁴, Stacey Q Wolfe²⁵, Eytan Raz⁸, Ricardo Hanel²⁶, Maskim Shapiro⁸, Adnan H Siddiqui¹⁰, William J Ares²⁷, Christopher S Ogilvy¹¹, Elad I Levy¹⁰, Ajith J Thomas^{11

28}, Visish M Srinivasan³, Robert M Starke¹², Andrew F Ducruet²⁹, Stavropoula I Tjoumakaris⁵, Brian Jankowitz^{3

30}, Felipe C Albuquerque³¹, Peter Kim Nelson⁸, Howard Riina⁸, Pedro Lylyk⁷, Demetrius Klee Lopes³², Pascal Jabbour⁵, Jan Karl Burkhardt¹

Affiliations

¹ Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA jan.burkhardt@pennmedicine.upenn.edu msalem_123@yahoo.com.
² Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
³ Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
⁵ Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁶ Endeavor Health Medical Group, Edward Hospital, Naperville, IL, USA.
⁷ Department of Interventional Neuroradiology and Neurosurgery, Instituto Médico ENERI Clínica La Sagrada Familia, Jose Hernandez, Buenos Aires, Argentina.
⁸ Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA.
⁹ Department of Interventional Neuroradiology, University of Florence, Florence, Italy.
¹⁰ Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
¹¹ Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, MA, USA.
¹² Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹³ Department of Neuroscience, Valley Baptist Medical Center, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.
¹⁴ Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA.
¹⁵ Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
¹⁶ Department of Neurosurgery, University of Nebraska, Omaha, Nebraska, USA.
¹⁷ Department of Neurosurgery, Baylor College of Medicine, Houston, TX , USA.
¹⁸ Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁹ Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
²⁰ Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA.
²¹ Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
²² Department of Neurosurgery, University of Washington, Seattle, WA, USA.
²³ Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.
²⁴ Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA.
²⁵ Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA.
²⁶ Department of Neurosurgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA.
²⁷ Department of Neurosurgery, Endeavor Health, Evanston, IL, USA.
²⁸ Department of Neurosurgery, Cooper University Health Care, Camden, NJ, USA.
²⁹ Department of Neurosurgery, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
³⁰ Department of Neurosurgery, JFK New Jersey Neuroscience Institute, Edison, NJ, USA.
³¹ Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
³² Advocate Medical Group, Chicago, IL, USA.

PMID: 40139781
DOI: 10.1136/jnis-2024-022422

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

Mohamed M Salem et al. J Neurointerv Surg. 2025.

. 2025 Mar 26:jnis-2024-022422.

doi: 10.1136/jnis-2024-022422. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA jan.burkhardt@pennmedicine.upenn.edu msalem_123@yahoo.com.
² Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
³ Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
⁵ Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁶ Endeavor Health Medical Group, Edward Hospital, Naperville, IL, USA.
⁷ Department of Interventional Neuroradiology and Neurosurgery, Instituto Médico ENERI Clínica La Sagrada Familia, Jose Hernandez, Buenos Aires, Argentina.
⁸ Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA.
⁹ Department of Interventional Neuroradiology, University of Florence, Florence, Italy.
¹⁰ Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
¹¹ Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, MA, USA.
¹² Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹³ Department of Neuroscience, Valley Baptist Medical Center, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.
¹⁴ Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA.
¹⁵ Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
¹⁶ Department of Neurosurgery, University of Nebraska, Omaha, Nebraska, USA.
¹⁷ Department of Neurosurgery, Baylor College of Medicine, Houston, TX , USA.
¹⁸ Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁹ Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
²⁰ Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA.
²¹ Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
²² Department of Neurosurgery, University of Washington, Seattle, WA, USA.
²³ Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.
²⁴ Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA.
²⁵ Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA.
²⁶ Department of Neurosurgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA.
²⁷ Department of Neurosurgery, Endeavor Health, Evanston, IL, USA.
²⁸ Department of Neurosurgery, Cooper University Health Care, Camden, NJ, USA.
²⁹ Department of Neurosurgery, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
³⁰ Department of Neurosurgery, JFK New Jersey Neuroscience Institute, Edison, NJ, USA.
³¹ Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
³² Advocate Medical Group, Chicago, IL, USA.

PMID: 40139781
DOI: 10.1136/jnis-2024-022422

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.

Keywords: Aneurysm; Stent.

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Conflict of interest statement

Competing interests: None declared.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

LinkOut - more resources

Full Text Sources