Repeat Flow Diversion for Cerebral Aneurysms Failing Prior Flow Diversion: Safety and Feasibility From Multicenter Experience

Mohamed M. Salem, Ahmad Sweid, Anna L. Kuhn, Adam A. Dmytriw, Santiago Gomez-Paz, Georgios A. Maragkos, Muhammad Waqas, Carmen Parra-Farinas, Arsalaan Salehani, Nimer Adeeb, Patrick Brouwer, Gwynedd Pickett, Jerry Ku, Victor X.D. Yang, Alain Weill, Ivan Radovanovic, Christophe Cognard, Julian Spears, Hugo H. Cuellar-Saenz, Leonardo RenieriPeter Kan, Nicola Limbucci, Vitor Mendes Pereira, Mark R. Harrigan, Ajit S. Puri, Elad I. Levy, Justin M. Moore, Christopher S. Ogilvy, Thomas R. Marotta, Pascal Jabbour, Ajith J. Thomas

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Aneurysmal persistence after flow diversion (FD) occurs in 5% to 25% of aneurysms, which may necessitate retreatment. There are limited data on safety/efficacy of repeat FD-a frequently utilized strategy in such cases. Methods: A series of consecutive patients undergoing FD retreatment from 15 centers were reviewed (2011-2019), with inclusion criteria of repeat FD for the same aneurysm at least 6 months after initial treatment, with minimum of 6 months post-retreatment imaging. The primary outcome was aneurysmal occlusion, and secondary outcome was safety. A multivariable logistic regression model was constructed to identify predictors of incomplete occlusion (90%-99% and <90% occlusion) versus complete occlusion (100%) after retreatment. Results: Ninety-five patients (median age, 57 years; 81% women) harboring 95 aneurysms underwent 198 treatment procedures. Majority of aneurysms were unruptured (87.4%), saccular (74.7%), and located in the internal carotid artery (79%; median size, 9 mm). Median elapsed time between the first and second treatment was 12.2 months. Last available follow-up was at median 12.8 months after retreatment, and median 30.6 months after the initial treatment, showing complete occlusion in 46.2% and near-complete occlusion (90%-99%) in 20.4% of aneurysms. There was no difference in ischemic complications following initial treatment and retreatment (4.2% versus 4.2%; P>0.99). On multivariable regression, fusiform morphology had higher nonocclusion odds after retreatment (odds ratio [OR], 7.2 [95% CI, 1.97-20.8]). Family history of aneurysms was associated with lower odds of nonocclusion (OR, 0.18 [95% CI, 0.04-0.78]). Likewise, positive smoking history was associated with lower odds of nonocclusion (OR, 0.29 [95% CI, 0.1-0.86]). History of hypertension trended toward incomplete occlusion (OR, 3.10 [95% CI, 0.98-6.3]), similar to incorporated branch into aneurysms (OR, 2.78 [95% CI, 0.98-6.8]). Conclusions: Repeat FD for persistent aneurysms carries a reasonable success/safety profile. Satisfactory occlusion (100% and 90%-99% occlusion) was encountered in two-thirds of patients, with similar complications between the initial and subsequent retreatments. Fusiform morphology was the strongest predictor of retreatment failure.

Original languageEnglish (US)
Pages (from-to)1178-1189
Number of pages12
JournalStroke
Volume53
Issue number4
DOIs
StatePublished - Apr 1 2022
Externally publishedYes

Keywords

  • aneurysm
  • follow-up studies
  • humans
  • retreatment
  • smoking

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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