Risk factors for incomplete occlusion in patients with small intracranial aneurysms (<7mm) after flow-diversion treatment: a multicenter experience

• DOI: 10.1159/000544991
• Publication Date: 2025-03-03T17:01:34Z
• Authors: Chi Huang; Xingwei Lei; Xin Feng; Xin Tong; Zhuohua Wen; Jiancheng Lin; Mengshi Huang; Chao Peng; Tao Wang; Wenxin Chen; Lele Dai; Xin Jin; Shixing Su; Xin Zhang; Xifeng Li; Zongduo Guo; Aihua Liu; Chuanzhi Duan

Introduction The indicator of flow diverters (FDs) received approval extension for small (<7 mm) unruptured intracranial aneurysms (UIAs). However, the factors related to aneurysm occlusion remain unclear. Thus, we conducted a multicenter analysis to explore the risk factors for incomplete occlusion (ICO) following FD implantation for small UIAs.

Methods We retrospectively reviewed patients from 5 comprehensive hospitals in China with small UIAs treated with either Pipeline or Tubridge between September 2018 and September 2022. Baseline data were prospectively collected at admission. The relationship between baseline characteristics and occlusion status was analyzed and multivariate logistic regression models were performed to identify the independently related factors.

Results A total of 565 patients with 565 small UIAs were enrolled. During a mean angiographic follow-up of 10.64 ± 5.99 months, ICO was detected in 116 cases (20.5%). After adjusting for candidate variables, hypertension (adjusted odds ratio [aOR] = 2.274, 95% confidence interval [CI] = 1.462-3.538, p <0.001), coronary disease (aOR = 2.742, 95%CI = 1.148-6.552, p = 0.023), larger aneurysm size (aOR = 1.833, 95%CI = 1.425-2.356, p <0.001), lower size ratio (SR, aOR = 0.380, 95% CI = 0.166-0.869, p = 0.022), and less coil application (aOR = 0.212, 95% CI = 0.061-0.741, p = 0.015) were independently associated with ICO of small UIAs.

Conclusion Hypertension, coronary disease, larger aneurysm size, lower SR, and less coil application were independent predictors of ICO for small UIAs after FD implantation. Neurointerventionalists should focus more on blood pressure management and aneurysm morphological assessment in flow-diversion treatment for small UIAs.