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Introduction/Purpose Prompt treatment of ruptured aneurysms is the standard of care, though later retreatment for residual or recurrent aneurysms may be necessary. Predictors of the need for retreatment after ruptured aneurysm repair have not been well described.Materials and Methods The NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) Cerebral Aneurysm Registry was queried for initial treatments of ruptured aneurysms. Reported cases of retreatment for previously ruptured aneurysms initially treated within the database were identified. Patient demographics, aneurysm characteristics, and treatment details were collected and compared between groups of patients that did and did not undergo retreatment of previously ruptured aneurysms. Potential predictors of retreatment between groups were also compared using univariate and multivariate binary logistic and Cox regression analysis. Time-to-retreatment based on initial treatment occlusion status and treatment method was analyzed using Kaplan-Meier survival curves.Results In the final analysis, 2321 initial rupture treatments with 185 (8.0%) reported retreatments were included. At time of rupture, patients that underwent retreatment were younger than those who did not (54.4 ±12.4 vs 56.7 ±14.3 years, p=0.035) and were more likely to have endovascular treatment (175/1905 endovascular vs 10/416 microsurgical, p<0.001). They had larger sized aneurysms (7.3 ±4.0 vs 6.3 ±4.4 mm, p=0.007) and a larger mean neck size (3.7 ±1.8 vs 3.1 ±2.2 mm, p=0.004). Retreatment occurred more frequently in patients with residual aneurysm dome (12%) and residual neck (12%) at treatment completion compared to those with complete occlusion (5%; p<0.001). On multivariate analysis, endovascular treatment (OR 4.13, 95%CI 1.25-13.66), incomplete aneurysm obliteration (OR 1.79, 95%CI 1.21-2.66), and neck (but not dome) size (OR 1.09 per mm increase, 95%CI 1.01-1.18) remained significant retreatment predictors. Kaplan Meier survival curves demonstrated significant differences in retreatment-free survival based on initial treatment aneurysm occlusion status and treatment method (log-rank p<0.001). On multivariate Cox regression analysis, residual aneurysm neck (HR 2.07 95%CI 1.40-3.07) and aneurysm dome (HR 1.98 95%CI 1.05-3.70) were independently associated with increased hazard of retreatment compared to complete occlusion. Median time to retreatment was 191 days (IQR 221), and 81.6% (151/185) retreatments occurred within the first year.Conclusion At least 8.0% of ruptured aneurysm were retreated. Independent predictors significantly associated with retreatment after rupture include initial endovascular treatment, incomplete aneurysm obliteration, and aneurysm neck size. These risk factors may help further delineate protocols for surveillance and retreatment strategies.Disclosures S. Shah: None. C. Fritch: None. E. Church: None. S. Simon: None. K. Cockroft: None. D. Wilkinson: None.Abstract P-024 Figure 1