{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA",
        "Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA"
      ],
      "name": "Mohamed M Salem"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA"
      ],
      "name": "Ahmed Helal"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA",
        "Department of Neurosurgery, Albany Medical Center, Albany, NY, USA"
      ],
      "name": "Avi A Gajjar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Georgios Sioutas"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA"
      ],
      "name": "Kareem El Naamani"
    },
    {
      "affiliations": [
        "Endeavor Health Medical Group, Edward Hospital, Naperville, IL, USA"
      ],
      "name": "Daniel M Heiferman"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology and Neurosurgery, Instituto Médico ENERI Clínica La Sagrada Familia, Jose Hernandez, Buenos Aires, Argentina"
      ],
      "name": "Ivan Lylyk"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA"
      ],
      "name": "Alex Levine"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, University of Florence, Florence, Italy"
      ],
      "name": "Leonardo Renieri"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Andre Monteiro"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, MA, USA"
      ],
      "name": "Mira Salih"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA"
      ],
      "name": "Rawad Abbas"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA"
      ],
      "name": "Ahmed Abdelsalam"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Valley Baptist Medical Center, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA"
      ],
      "name": "Sohum Desai"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA"
      ],
      "name": "Hamidreza Saber"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Joshua S Catapano"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA",
        "Department of Neurosurgery, University of Nebraska, Omaha, Nebraska, USA"
      ],
      "name": "Nicholas Borg"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Giuseppe Lanzino"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Waleed Brinjikji"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Baylor College of Medicine, Houston, TX , USA"
      ],
      "name": "Omar Tanweer"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Alejandro M Spiotta"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA"
      ],
      "name": "Min S Park"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA"
      ],
      "name": "Aaron S Dumont"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA"
      ],
      "name": "Adam S Arthur"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Washington, Seattle, WA, USA"
      ],
      "name": "Louis J Kim"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Washington, Seattle, WA, USA"
      ],
      "name": "Michael R Levitt"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA"
      ],
      "name": "Peter Kan"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA"
      ],
      "name": "Ameer E Hassan"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, University of Florence, Florence, Italy"
      ],
      "name": "Nicola Limbucci"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA"
      ],
      "name": "Geoffrey P Colby"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA"
      ],
      "name": "Stacey Q Wolfe"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA"
      ],
      "name": "Eytan Raz"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA"
      ],
      "name": "Ricardo Hanel"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA"
      ],
      "name": "Maskim Shapiro"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Adnan H Siddiqui"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Endeavor Health, Evanston, IL, USA"
      ],
      "name": "William J Ares"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, MA, USA"
      ],
      "name": "Christopher S Ogilvy"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Elad I Levy"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, MA, USA",
        "Department of Neurosurgery, Cooper University Health Care, Camden, NJ, USA"
      ],
      "name": "Ajith J Thomas"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Visish M Srinivasan"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA"
      ],
      "name": "Robert M Starke"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, St Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA"
      ],
      "name": "Andrew F Ducruet"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA"
      ],
      "name": "Stavropoula I Tjoumakaris"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA",
        "Department of Neurosurgery, JFK New Jersey Neuroscience Institute, Edison, NJ, USA"
      ],
      "name": "Brian Jankowitz"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA"
      ],
      "name": "Felipe C Albuquerque"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA"
      ],
      "name": "Peter Kim Nelson"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA"
      ],
      "name": "Howard Riina"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology and Neurosurgery, Instituto Médico ENERI Clínica La Sagrada Familia, Jose Hernandez, Buenos Aires, Argentina"
      ],
      "name": "Pedro Lylyk"
    },
    {
      "affiliations": [
        "Advocate Medical Group, Chicago, IL, USA"
      ],
      "name": "Demetrius Klee Lopes"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA"
      ],
      "name": "Pascal Jabbour"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Jan Karl Burkhardt"
    }
  ],
  "title": "Multicenter analysis of flow diversion for recurrent/persistent intracranial aneurysms after stent-assisted coiling",
  "uid": "0fe2825e-9b2f-5fdc-865b-3a9d2eda76c8"
}