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Objective This study aimed to evaluate the feasibility and safety values of activated clotting time (ACT)-guided systemicheparinization in reducing periprocedural thrombosis and bleeding complications during coil embolization of unrupturedintracranial aneurysms.Methods A total of 228 procedures performed on 213 patients between 2016 and 2021 were included in the retrospectiveanalysis. The target ACT was set at 250 s. Logistic regression was performed to assess predictors for the occurrence ofthrombosis and bleeding. Receiver operating characteristic (ROC) analyses were employed to determine the optimal cut-offvalues for ACT, heparinization, and procedure time.Results Most (85.1%) of procedures were stent-assisted embolization. The mean baseline ACT was 128.8 ± 45.7 s. Themean ACT at 20 min after the initial intravenous heparin loading of 78.2 ± 18.8 IU/kg was 185 ± 46.4 s. The mean peakACT was 255.6 ± 63.8 s with 51.3% (117 cases) achieving the target ACT level. Peak ACT was associated with symptomaticthrombosis (OR per second, 1.008; 95% CI, 1.000-1.016; P = 0.035) (cut-off value, 275 s; area under ROC (AUROC),0.7624). Total administered heparin dose per body weight was negatively associated with symptomatic thrombosis (OR perIU/kg, 0.972; 95% CI, 0.949-0995; P = 0.018) (cut-off value, 294 IU/kg; AUROC, 0.7426) but positively associated withsignificant bleeding (OR, 1.008 per IU/kg; 95% CI, 1.005-1.012; P <0 .001) (cut-off value, 242 IU/kg; AUROC, 0.7391).Procedure time was significantly associated with symptomatic thrombosis (OR per minute, 1.05; 95% CI, 1.017-1.084; Pvalue = 0.002) (cut-off value, 158 min; area under ROC, 0.8338).Conclusion This study demonstrated that ACT-guided systemic heparinization was feasible to achieve the target ACT valueand proposes probable safety thresholds to prevent periprocedural complications through reducing procedure time duringcoil embolization of unruptured intracranial aneurysms in the stent era.Disclosures H. Jang: None. B. Cho: None. D. Jang: None. D. Kim: None.