A285 Incidence and risk factors of microstroke lesions after stent treatment of unruptured wide-necked intracranial aneurysms: a prospective cohort study

<h3>Introduction</h3> No study has specifically compared the occurrence of DWI(+) and SWI(+) after treatment of unruptured wide-necked intracranial aneurysms (UWIAs) with LVIS versus flow-diverting (FD) devices. <h3>Aim of study</h3> This study aims to investigate the risk factors and correlations associated with ischemic and hemorrhagic strokes, DWI(+), and SWI(+) following LVIS versus FD treatment for UWIAs. <h3>Method</h3> A prospective cohort study included adult patients with UWIAs treated with LVIS or FD devices from March 2024 to March 2025. Clinical data, pre- and post-operative DWI and SWI imaging, and postoperative outcomes were collected (ChiCTR2400083488). <h3>Results</h3> A total of 129 patients were included (mean age 57.9±10.6 years). DWI(+) was observed in 79 patients (61.0%) and SWI(+) in 61 patients (47.3%). The DWI(+) group had more coils used (P=0.007), greater aneurysm calcification (P=0.001), and more intracranial arteriosclerosis (P=0.001). LVIS treatment was associated with a higher incidence of DWI(+) (67.1% vs. 32.9%, P=0.001). For SWI(+), the group had more intracranial artery stenosis (P=0.005), longer procedural times (P=0.043), and more arterial calcification (P=0.020). LVIS also showed a higher incidence of SWI(+) (68.9% vs. 31.1%, P=0.012). <h3>Conclusion</h3> LVIS stenting, greater coil usage, intracranial arteriosclerosis, and stenosis were associated with a higher likelihood of postoperative DWI(+). Longer procedural times were also linked to DWI(+). LVIS stenting, longer procedure times, and intracranial artery stenosis and calcification were identified as potential risk factors for postoperative SWI(+). Changes in aneurysm-feeding artery morphology and excessive microcatheter height may increase the risk of SWI(+). <h3>Conflict of Interest</h3> No