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Introduction/Purpose Uncertainty persists regarding the benefit of adjunctive coiling in conjunction with flow diversion for intracranial aneurysms. This approach generally requires jailing a coiling microcatheter adjacent to the flow diverting stent (FDS). Theoretically, removal of the jailed microcatheter may produce an endoleak, whereby incomplete stent apposition permits persistent blood flow between the stent and parent vessel wall. Although this may reduce the likelihood of aneurysm occlusion, the effect could be mitigated by the presence of coils within the aneurysm sac. Accordingly, we sought to evaluate flow diversion characteristics before, during, and after microcatheter jailing in an aneurysm model under physiological flow conditions.Materials and Methods A pulsatile hemodynamic simulation circuit was used to circulate blood-mimicking fluid under physiologic arterial waveforms through a silicone internal carotid artery aneurysm model. Five different conditions were evaluated: 1) No FDS (control), 2) FDS (Pipeline Flex) alone, 3) FDS with jailed microcatheter, 4) FDS following microcatheter removal, and 5) FDS following microcatheter removal with adjunctive angioplasty. For each condition, 6 digital subtraction angiography (DSA) cine runs were captured using C-arm fluoroscopy while an automated injector was used to inject 6.00ml of contrast at 4.00ml/s. Images were analyzed in MATLAB using a proximal parent vessel region of interest (ROI) for contrast arrival detection and an aneurysm ROI for flow quantification, yielding normalized time-density curves (TDC). Differences between conditions were assessed using Welch’s one-way ANOVA followed by pairwise Welch t-tests and Holm correction.Results TDCs demonstrated accelerated contrast washout following microcatheter removal (condition 4) compared with both the FDS control (condition 2) and the FDS with a jailed microcatheter (condition 3). This was partially reversed with adjunctive angioplasty (condition 5). The greatest intra-aneurysmal contrast stasis occurred in the presence of a jailed microcatheter (condition 3). ( figure 1)Conclusion Our findings support the hypothesis that removal of a jailed microcatheter may result in an endoleak, as evidenced by reduced flow diversion following its removal, and this was partially reversed with angioplasty. The enhanced flow diversion observed in the presence of the microcatheter may be attributable to additional flow disruption caused by the microcatheter inside the aneurysm dome. Further studies are warranted across different aneurysm models, and with different microcatheter positions, to evaluate the impact of jailed microcatheter utilization in the setting of flow diversion.Disclosures E. Hu: None. A. Nanji: None. C. Veilleux: None. P. Croney: None. M. Eesa: 4; C; Fluid Biomed Inc. A. Mitha: 2; C; Stryker, MicroVention. 4; C; Fluid Biomed Inc.Abstract E-209 Figure 1