Abstract 391: Real‐World Flow Diverter Experience: Imaging Outcomes and Predictors of Aneurysm Occlusion

Introduction/Purpose Flow diverter devices (FDD) are endoluminal stents that have emerged to provide an excellent treatment option for many patients with giant, complex, fusiform and/or wide neck aneurysms. Multiple studies have shown reasonable occlusion rates with FDDs with low morbidity and mortality, but data is scarce on predictors of aneurysm persistent filling after treatment. Our aim was to identify long‐term imaging outcomes with different FDD. Methods and Materials Single tertiary care center retrospective analysis, including patients with ruptured or unruptured intracranial aneurysms, treated with FDD over 7 years. Results A total of 398 patients were included in the study. Average age was 56 (+/‐14) years, 82% were female. Most patients were current or prior smokers (53%). About 15% had positive family history and 60% had a history of hypertension. Most aneurysms were incidental and asymptomatic (76.1%); only 25 patients (6.3%) presented with a ruptured aneurysm, and 70 patients (17.6%) had unruptured symptomatic aneurysms (headache in 62%). The most common location was the ophthalmic artery (34%), most were saccular in morphology (79%) and measured <10 mm in size (76%). The most common device used was the Pipeline shield FDD (70%) followed by Surpass Evolve FDD (24%). Most patients (87%) had a follow‐up angiogram between 6 months to 1 year after initial FDD embolization procedure. The average time from intervention to follow‐up imaging was 11.2 months, at which point 70% of patients achieved complete occlusion of the treated aneurysm. Patients who had further follow‐up, had a spontaneous occlusion rate of about 22%. Significant predictors for residual filling included a major artery originating from the aneurysm's neck/dome/fundus, larger aneurysm size (>10 mm) without adjunct coiling, or fusiform morphology. Conclusion We confirm previous findings that FDD are a durable treatment for intracranial aneurysms with an excellent occlusion rate. We identified predictors of residual filling after treatment, which can guide treatment decisions for aneurysms with an artery originating from the aneurysm, larger size and fusiform aneurysm type.