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Introduction In-stent stenosis remains a potential complication of endovascular flow diversion despite evolving stent designs and improved compatibility. While first-generation flow diverters demonstrated variable rates of in-stent stenosis, newer-generation devices with ameliorated braid design and surface modifications aim to reduce thrombogenicity. There is limited published data surrounding the novel Surpass Elite stenosis rates. The current study evaluates in-stent stenosis after Surpass Elite implantation in an effort to provide insight into its safety and implications for post-procedural monitoring.Methods An IRB-approved, prospectively maintained database of the senior authors’ cases was reviewed to identify patients treated with flow diversion embolization using the Surpass Elite device with followup. Patient demographics, aneurysm characteristics, and procedural outcomes were collected.Results Over a 7 month study period, 87 flow diversion cases using the Surpass Elite were performed and analyzed. Follow-up angiography was completed in 51 patients (59%) at 5.9 ± 0.1 months. Mean age was 64 ± 1.6 years, 65% were female (33 cases). The cohort were majority white (37 cases, 73%) and Hispanic (12 cases, 24%). Presenting symptoms included headaches (11 cases, 22%), stroke (5 cases, 10%), weakness (4 cases, 8%), SAH (4 cases, 8%), trauma (3 cases, 6%), and other incidental findings (11 cases, 22%). On latest follow-up, none to mild in-stent stenosis was observed in 45 cases (88%) and moderate stenosis in 6 cases (12%). No cases of severe in-stent stenosis occurred. Two-percent (n=2) overall complication rate with a patient presenting with stroke following DAPT noncompliance, and a mortality secondary to sequela of delayed subdural hematoma.Conclusion This study demonstrates favorable in-stent stenosis rates with the Surpass Elite flow diverter. Notably, no cases of severe in-stent stenosis were observed in this cohort supporting the safety of this novel device.Disclosures J. Campos: 2; C; Rapid Medical. J. Collard de Beaufort: None. K. Van Orden: None. M. Arthur: None. B. Polis: None. J. Hamilton: None. F. Laghari: None. N. Beaty: 6; C; proctor for Medtronic Neurovascular, Stryker Neurovascular, and CMO of NeuroMedica. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Rapid Medical, Cerenovus, and Stryker Neurovascular. A.L. Coon: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Cerenovus, Rapid Medical, Avail MedSystems, Imperative Care, Deinde, InNeuroCo, Q’apel. 6; C; proctor for MicroVention-Termo, Stryker Neurovascular, and Medtronic Neurovascular.Abstract E-256 Figure 1Illustrative case of a 61-year-old female presenting with a 6mm anterior communicating aneurysm (A). Flow diversion using a Surpass Elite 4x12 stent (B) with 6-month follow-up angiography demonstrating complete obliteration with moderate, non-flow-limiting, in-stent stenosis