P02 Acute intraprocedural thrombosis after flow diverter stent implantation: risk factors and relevance of standard observation time for early detection and management

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Introduction Acute intraprocedural thrombosis (AIT) is a severe complication of flow diverter stent (FDS) implantation for the treatment of intracranial aneurysms. Even though device-related thromboembolic complications are well known, there are no acknowledged risk factors nor defined surveillance protocols for their early detection. Aim of study This study aimed to demonstrate that an angiographic active surveillance time is justified and effective to detect and treat AIT. Methods A prospective institutional protocol consisting of a defined observation period of 30 min following FDS deployment was established to detect AIT. Overall incidence, as well as the efficacy and safety of AIT treatment was assessed. Moreover, radiological and clinical outcomes of patients with AIT were analysed. The influence of various patient- and procedure-related factors on the occurrence of AIT was investigated using multivariable forward logistic regression. Results Twelve cases of AIT were observed among a total of 161 procedures (incidence: 7.5%). The mean time of first observation was 16.2 minutes after FDS implantation. Patients with pre-existing arterial hypertension and side branches originating from the aneurysmal sac had a higher risk of AIT (respectively OR, 9.844; OR, 3.553). All patients were promptly treated with intravenous application of a glycoprotein IIb/IIIa inhibitor, which led to complete thrombus resolution in all cases without haemorrhagic complications. Conclusion Active surveillance for 30 min after FDS implantation is an effective strategy for early detection and ensuing treatment of AIT, thus preventing secondary sequalae. Hypertension and side branches originating from the aneurysmal sac may increase the risk of AIT. References The Original Article Has Not Been Published Yet. Patel A et al. Early Angiographic Signs of Acute Thrombus Formation Following Cerebral Aneurysm Treatment with the Pipeline Embolization Device. J Neurointerv Surg. 2017;9(11):1125–30. Al-Mufti F et al. Bailout Strategies and Complications Associated with the Use of Flow-diverting Stents for Treating Intracranial Aneurysms. Interv Neurol. 2020;8(1):38–54. Lin LM et al. Abciximab (Reopro) Dosing Strategy for the Management of Acute Intraprocedural Thromboembolic Complications during Pipeline Flow Diversion Treatment of Intracranial Aneurysms. Interv Neurol 2018;7(5):218–32. Do you have any conflict of interest to declare?: No

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