1087. Evaluation of the Safety and Efficacy of the Flow Diversion for Multiple Intracranial Aneurysms

Authors: Yasmeen Elsawaf; Robert Rennert, MD; David Santiago-Dieppa, MD; Jeffrey Steinberg, MD; Arvin Wali, MD; Scott Olson, MD; J Pannell, MD; Alexander Khalessi, MD (Orlando, FL)

Introduction: Despite increasing on- and off-label use of the flow-diverter Pipeline Embolization Device (PED) for wide-necked intracranial aneurysms, data on PED use for multiple intracranial aneurysms (tandem or arising from a separate vessel) is limited. Methods: Retrospective review of a single-institution prospective database was conducted between March 2013 and April 2018 to identify patients with multiple anterior circulation intracranial aneurysms treated with flow-diverter PEDs. Intra-operative complications (ICH or stroke), aneurysm occlusion/reoccurrence rates, and median modified Rankin Scale (mRS) on follow up were recorded. Results: Six patients with multiple intracranial aneurysms (15 total) had 13 total aneurysms treated with 9 PEDs. 3/6 (50%) patients presented with sub-arachnoid hemorrhage (SAH), with initial securement of the ruptured aneurysm via clipping or coiling and delayed flow diversion of recurrence/residual lesions, if needed. Three patients had tandem aneurysms (n=6) treated with the same PED, two patients had bilateral ICA aneurysms (n=4) requiring staged PEDs, and one patient had one right and two left tandem ICA aneurysms (n=3) treated with bilateral, staged PEDs. There was a 0% incidence of peri-operative ICH and ischemic stroke. Angiographic occlusion rate was 92.3% (n=12/13) at 1-year. Median discharge and 30-day mRS was 0 (range: 0-1), with this excellent neurologic status maintained at 1-year follow up. Conclusion: The use of a flow-diverters for the management of multiple intracranial aneurysms is effective and safe.