{
  "abstract": "Background Residual or recurrent anterior communicating artery (AComm) aneurysms after prior endovascular treatment represent a challenging subgroup for retreatment. Repeat coiling or microsurgical clipping may be technically difficult depending on aneurysm morphology, prior device construct, and remnant characteristics. Flow diversion has emerged as a reconstructive option, but published experience in previously treated AComm aneurysms remains limited.Objective To describe the safety and imaging outcomes of Pipeline embolization for residual or recurrent AComm aneurysms at a single center.Methods We performed a retrospective review of consecutively treated patients with residual or recurrent previously treated AComm aneurysms who underwent Pipeline embolization at a single tertiary care center between 2017 and 2024. Demographic, procedural, imaging, and clinical outcome data were collected from an institutional database. Follow-up consisted of catheter angiography at or before 1 year, with cross-sectional vascular imaging thereafter. The primary efficacy outcome was aneurysm occlusion on follow-up imaging using the Raymond-Roy Occlusion Classification when angiographic follow-up was available. Safety outcomes included procedural complications, new ischemic injury, in-stent stenosis, and mortality.Results Six patients met inclusion criteria. Mean age was 54.5 years (range 32-76), and 4/6 patients (66.7%) were female. Prior treatment consisted of endovascular therapy, including coiling in most cases. Pipeline deployment was technically successful in all 6 cases. Follow-up occlusion data were available for 5 patients. Complete occlusion was observed in 4/5 cases (80.0%), and residual neck filling in 1/5 case (20.0%). No patient with follow-up demonstrated persistent aneurysm filling. Treatment-related adverse events included one asymptomatic territorial infarct, one asymptomatic mild in-stent stenosis, and one access-site dissection related to prior treatment. There were no deaths.Conclusions In this single-center experience, Pipeline embolization was a feasible treatment strategy for selected residual or recurrent AComm aneurysms after prior endovascular treatment. Most patients with follow-up imaging achieved complete occlusion, with an acceptable safety profile. Larger multicenter studies are needed to better define the role of flow diversion in this uncommon but challenging retreatment population.Disclosures Z. Nigogosyan: None.",
  "authors": [
    {
      "affiliations": [
        "Radiology, Washington University, St. Louis, MO"
      ],
      "name": "Z Nigogosyan"
    },
    {
      "affiliations": [
        "School of Medicine, Washington University in St. Louis, St. Louis, MO"
      ],
      "name": "U Mani"
    },
    {
      "affiliations": [
        "Neurological Surgery, Washington University School of Medicine, St. Louis, MO"
      ],
      "name": "J Osbun"
    }
  ],
  "title": "E-249 Flow diversion for residual or recurrent anterior communicating artery aneurysms after prior endovascular treatment: a single-center experience",
  "uid": "081bec79-731a-5428-a089-1537046de048"
}