Cerebral Flow Diverter: Pioneering Insights From A Tertiary Care Hospital In A Developing Nation

Abstract: Objective: To record the early experience about the cerebral flow diverters (CFD) utilization and outcomes at a tertiary care hospital of Pakistan. Study design: Retrospective cohort study. Place and duration: Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan. Material and methods: A retrospective review was conducted on patients who underwent CFD placement for cerebral aneurysms at our tertiary care center between 2017 and 2025. Data collected included patient demographics, aneurysm features, procedural details, and both immediate and six-month post-procedure outcomes, such as occlusion rates and any complications. The extent of aneurysm occlusion—categorized as complete or incomplete—was determined based on angiographic imaging obtained immediately following CFD deployment. Results: In a total of 27 patients, 16 (56.3%) were female and 11 (40.1%) male with mean age of 43.22 ± 17.86 years. The mean aneurysm size was calculated to be 17.87 ± 7.78 mm, whereas 22 (81.48%) were wide necked aneurysms (≥ 25 mm). Immediate post-procedural assessments displayed a 100% success rate in completing the intended procedure successfully across all 27 cases. Immediate angiogram revealed that 15 (55.56%) patients achieved complete contrast stasis/occlusion within the cerebral aneurysms, while 12 (44.4%) displayed partial contrast stasis/occlusion. In the shorter-term follow-up evaluation, 25 (92.59%) cases exhibited complete occlusion of the aneurysms with only 2 (7.41%) patients showing procedure failure, signifying a sustained positive outcome in terms of aneurysm closure. Complications were reported in 4 (4.2%) patients with 2 patients showing aneurysm wall enhancement, 1 patient showing acute thrombosis, and endoleak each. Conclusion: Despite limited resources, our center achieved good clinical outcomes, aneurysm occlusion rates, and procedural success. The occurrence of complications in a subset of cases underscores the necessity for continued refinement of patient selection criteria and procedural techniques to optimize outcomes and mitigate risks in the evolving landscape of endovascular interventions for cerebral aneurysms.