Impact of angiotensin-converting-enzyme inhibitors on intracranial aneurysm endovascular treatment outcome.

PURPOSE: Angiotensin-converting enzyme inhibitors (ACEis) are commonly prescribed antihypertensive medications. They also possess antiplatelet properties. The aim of this single-center retrospective observational cohort study was to analyze whether intake of ACEis may increase the risk of incomplete aneurysm occlusion after this treatment modality. METHODS: We retrospectively included patients hospitalized between January 2015 and June 2024 with unruptured intracranial aneurysm, who underwent endovascular treatment with coiling or Flow Diverter (FD) placement. Imaging data (at 6 months and 18 months follow-up) were collected. We gathered information about the occlusion status at both follow-up examinations. Univariate analysis was conducted using χ2 and t-tests, and multivariate analysis employed logistic regression. RESULTS: A total of 126 patients with 131 aneurysms were included in coiling group and 134 patients with 149 aneurysms were included in FD group. At baseline, ACEis were used by 49 patients in the coiling group and 40 patients in the flow diverter group. Patients treated with flow diversion or stent-assisted coiling received standard antiplatelet therapy and none were on oral anticoagulation. The most commonly used ACEis were ramipril (57.30%), perindopril (32.58%), and lisinopril (10.11%). Twenty-six aneurysms (19.9%) from the coiling group were recanalized on the first follow-up examination. Patients with recanalized aneurysms were significantly more likely to take ACEis (61.54% vs. 31.43%; p < 0.01). In multivariable analysis, the logistic regression model identified aneurysm ACEis intake (OR:3.65;95% CI:1.2–11.83;p = 0.02) as an independent predictor of aneurysm recanalization at the first follow-up. Sixty-eight aneurysms (45.64%) from the FD group were incompletely occluded at the first follow-up examination. Similarly to coiling group, patients with non-totally occluded aneurysms were more likely to take ACEis (36.76% vs. 18.51%;p = 0.01). In multivariate analysis, intake of ACEis (OR:2.86;95% CI:1.34–6.29;p < 0.01) significantly increased risk of incomplete occlusion at first follow-up. CONCLUSIONS: ACEis intake might reduce the rate of total aneurysm occlusion after endovascular treatment.