Low-Dose Glucocorticoids Adjunctive to Flow Diverter Therapy for Unruptured Intracranial Aneurysms Improve Cerebrovascular Outcomes

Abstract Flow diverter (FD) implantation is standard for unruptured intracranial aneurysms (UIAs), but cerebrovascular complications persist. This nested study within a prospective multicenter cohort evaluates whether short-term, low-dose glucocorticoid use is associated with cerebrovascular outcomes after FD implantation. Propensity-score matching with exact matching on UIA location yielded 1327 patients (360 glucocorticoid-treated; 967 controls). Intravenous glucocorticoids, initiated within 2 hours of the FD procedure and administered for ≥2 days, were associated with fewer in-hospital cerebrovascular events (6.9% vs. 13.1%; adjusted odds ratio [aOR], 0.53) and major cerebrovascular events (4.7% vs. 12.4%; aOR, 0.37). Over a median 2-year follow-up, glucocorticoid use was also associated with fewer new-onset major cerebrovascular events (3.6% vs. 8.7%; adjusted hazard ratio, 0.41) and less in-stent stenosis (7.9% vs. 13.2%; aOR, 0.55). Findings remained robust in unmatched patients on sensitivity analyses. We demonstrate that perioperative glucocorticoid regimens may reduce cerebrovascular events and in-stent stenosis in FD-treated patients, warranting randomized trials.