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Introduction True risk of aneurysm hemorrhage or rehemorrhage following flow diversion stems from the duration an aneurysm remains unoccluded after treatment. Nonetheless, most existing literature emphasizes final occlusion rates as the primary efficacy metric, rather than evaluating early angiographic occlusion at first follow-up. Predictors of complete occlusion include neck width, absence of hypertension, adjunctive coiling, and immediate post-deployment occlusion and longer follow-up. However, the temporal dynamics of occlusion remain underexplored.Methods To identify antithrombotic, procedural, aneurysmal, and device-related predictors of complete aneurysm occlusion—defined as Raymond-Roy Occlusion Classification I or O’Kelly-Marotta Grade D—at the first digital subtraction angiography (DSA) follow-up, Cox regression analysis using a backward likelihood-ratio method was performed on a prospectively maintained institutional database of 765 intracranial aneurysms treated with flow diversion from 2013 to 2024.Results Significant negative predictors of complete aneurysm occlusion included: older age (HR=0.989/year, p=0.005), long-term ongoing single (HR=0.639, p=0.004) or dual (HR=0.393, p<0.001) antiplatelet therapy versus none, use of surface-modified flow diverters (HR=0.491, p<0.001; figure 1), larger proximal arterial diameter (HR=0.775 per mm, p=0.006), and longer discharge antiplatelet duration (HR=0.999/day, p<0.001) (table 1). Cox regression analysis specific to Pipeline Embolization Devices (PED) revealed similar patterns, with lower rates of complete aneurysm occlusion associated with the use of PED Shield (HR=0.51, p<0.001) or PED Vantage (HR=0.574, p=0.08) compared to PED Classic/PED Flex (table 2).Conclusion The study provides valuable insights into optimizing antiplatelet management at discharge to enhance aneurysm occlusion at the earliest angiographic follow-up, particularly in patients on long-term antiplatelet therapy for conditions such as CAD, prior strokes, or PVD. Additionally, the study highlights the negative impact of surface-modified flow diverters on aneurysm occlusion. While these devices are designed to reduce intimal hyperplasia by mimicking endothelial components and attenuating foreign body and platelet responses, they appear to slow down occlusion and complete coverage of the aneurysm neck.Disclosures V. Jaikumar: None. V. Sridhar: None. J. Lim: None. B. Okai: None. P. Wahlig: None. E. Levy: None.Abstract P-028 Figure 1Abstract P-028 Figure 2