PURPOSE: Flow diverting stents have revolutionized the treatment of intracranial aneurysms through endoluminal reconstruction of the parent vessel. Despite this, certain aneurysms require retreatment. The purpose of this study was to identify clinical and radiologic determinants of aneurysm retreatment following flow diversion. METHODS: A multicenter flow diversion database was evaluated to identify patients presenting with an unruptured, previously untreated aneurysm with a minimum of 12 months' clinical and angiographic follow-up. Univariate and multivariate logistic regression modeling was performed to identify determinants of retreatment. RESULTS: We identified 189 aneurysms treated in 189 patients with a single flow-diverting stent. Mean age was 54 years, and 89% were female. Complete occlusion was achieved in 70.3% and 83.6% of patients at six and 12 months, respectively. Aneurysm retreatment with additional flow-diverting stents occurred in 5.8% of cases. Univariate analysis revealed that dome diameter ≥10 mm (p = 0.012), pre-clinoid internal carotid artery location (p = 0.012), distal > proximal parent vessel diameter (p = 0.042), and later dual antiplatelet therapy (DAPT) discontinuation (p < 0.001) were predictive of retreatment. Multivariate analysis identified discontinuation of DAPT >12 months (p = 0.003) as a strong determinant of retreatment with dome diameter ≥10 mm trending toward statistical significance (p = 0.064). Large aneurysm neck diameter, presence of aneurysm branch vessels, patient age, smoking history, and hypertension were not determinant of retreatment on multivariate analysis. CONCLUSIONS: Prolonged DAPT is the most important determinant of aneurysm retreatment following single-device flow diversion. Abbreviating DAPT duration to only six months should be a consideration in this population, especially for patients with a large aneurysm dome diameter.
PURPOSE: Flow diverting stents have revolutionized the treatment of intracranial aneurysms through endoluminal reconstruction of the parent vessel. Despite this, certain aneurysms require retreatment. The purpose of this study was to identify clinical and radiologic determinants of aneurysm retreatment following flow diversion. METHODS: A multicenter flow diversion database was evaluated to identify patients presenting with an unruptured, previously untreated aneurysm with a minimum of 12 months' clinical and angiographic follow-up. Univariate and multivariate logistic regression modeling was performed to identify determinants of retreatment. RESULTS: We identified 189 aneurysms treated in 189 patients with a single flow-diverting stent. Mean age was 54 years, and 89% were female. Complete occlusion was achieved in 70.3% and 83.6% of patients at six and 12 months, respectively. Aneurysm retreatment with additional flow-diverting stents occurred in 5.8% of cases. Univariate analysis revealed that dome diameter ≥10 mm (p = 0.012), pre-clinoid internal carotid artery location (p = 0.012), distal > proximal parent vessel diameter (p = 0.042), and later dual antiplatelet therapy (DAPT) discontinuation (p < 0.001) were predictive of retreatment. Multivariate analysis identified discontinuation of DAPT >12 months (p = 0.003) as a strong determinant of retreatment with dome diameter ≥10 mm trending toward statistical significance (p = 0.064). Large aneurysm neck diameter, presence of aneurysm branch vessels, patient age, smoking history, and hypertension were not determinant of retreatment on multivariate analysis. CONCLUSIONS: Prolonged DAPT is the most important determinant of aneurysm retreatment following single-device flow diversion. Abbreviating DAPT duration to only six months should be a consideration in this population, especially for patients with a large aneurysm dome diameter.
Authors: Raghav Gupta; Justin M Moore; Christoph J Griessenauer; Nimer Adeeb; Apar S Patel; Roy Youn; Karen Poliskey; Ajith J Thomas; Christopher S Ogilvy Journal: World Neurosurg Date: 2016-09-15 Impact factor: 2.104
Authors: Leonardo B C Brasiliense; Pedro Aguilar-Salinas; David A Miller; Rabih G Tawk; Eric A Sauvageau; Ricardo A Hanel Journal: World Neurosurg Date: 2017-08-24 Impact factor: 2.104
Authors: Ahmad Sweid; Robert M Starke; Nabeel Herial; Nohra Chalouhi; Somnath Das; Michael P Baldassari; Tyler D Alexander; Stavropoula Tjoumakaris; M Reid Gooch; David Hasan; Robert H Rosenwasser; Victor Romo; Pascal Jabbour Journal: Neurosurgery Date: 2020-09-15 Impact factor: 4.654
Authors: Tibor Becske; Waleed Brinjikji; Matthew B Potts; David F Kallmes; Maksim Shapiro; Christopher J Moran; Elad I Levy; Cameron G McDougall; István Szikora; Giuseppe Lanzino; Henry H Woo; Demetrius K Lopes; Adnan H Siddiqui; Felipe C Albuquerque; David J Fiorella; Isil Saatci; Saruhan H Cekirge; Aaron L Berez; Daniel J Cher; Zsolt Berentei; Miklós Marosfoi; Peter K Nelson Journal: Neurosurgery Date: 2017-01-01 Impact factor: 4.654
Authors: Tibor Becske; David F Kallmes; Isil Saatci; Cameron G McDougall; István Szikora; Giuseppe Lanzino; Christopher J Moran; Henry H Woo; Demetrius K Lopes; Aaron L Berez; Daniel J Cher; Adnan H Siddiqui; Elad I Levy; Felipe C Albuquerque; David J Fiorella; Zsolt Berentei; Miklós Marosfoi; Saruhan H Cekirge; Peter K Nelson Journal: Radiology Date: 2013-02-15 Impact factor: 11.105
Authors: Hanieh Moshayedi; Oluwaseun A Omofoye; Edward Yap; Taofik O Oyekunle; Deanna M Sasaki-Adams; Sten Y Solander Journal: World Neurosurg Date: 2017-04-27 Impact factor: 2.104
Authors: Anthony Peret; Benjamin Mine; Thomas Bonnet; Noémie Ligot; Jason Bouziotis; Boris Lubicz Journal: Neuroradiology Date: 2020-03-13 Impact factor: 2.804