Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms

Flow diverters (FDs) are increasingly used for cerebral aneurysms, including distal anterior cerebral artery (DACA) aneurysms, but comparative data between devices in this challenging location are limited. To compare the safety and efficacy of Pipeline, Silk Vista Baby (SVB), and FRED Jr. FDs for unruptured DACA aneurysms and identify predictors of complete occlusion. We retrospectively analyzed 166 patients treated with FDs at 39 centers in 14 countries (2018–2022) from the CRETA registry. Outcomes included aneurysm occlusion (O’Kelly–Marotta [OKM] scale), complications, retreatment, modified Rankin Scale (mRS) scores, and independent predictors of complete occlusion using multivariable Cox regression. Aneurysms were predominantly saccular and located on the pericallosal artery. Complete occlusion (OKM D) was achieved in 73%, and neck remnants (OKM C) in 12%, with no differences across devices. Ischemic complications occurred in 11% (mostly asymptomatic), hemorrhagic complications in 5%, and in-stent stenosis in 17%. Retreatment was performed in 1.3%. At last follow-up, 98% had mRS ≤ 2. Independent predictors of complete occlusion were female sex (HR 1.85), asymptomatic presentation (HR 1.79), smaller aneurysm neck (HR 0.83/mm), radial access (HR 2.20), and aspirin plus ticagrelor therapy (HR 1.84); device type was not predictive. Pipeline, SVB, and FRED Jr. FDs show similar safety and efficacy for unruptured DACA aneurysms. Complete occlusion is influenced by clinical and procedural factors, supporting individualized device selection.

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Publication Details

Journal
Neurological Sciences
Published
2026-02-18
DOI
https://doi.org/10.1007/s10072-026-08869-w
Primary Topic
Intracranial Aneurysms: Treatment and Complications
Type
article
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article

Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms

R Rautio, Ángel Ferrario, Guillaume Bellanger, G Boulouis et al.
Neurological Sciences
Intracranial Aneurysms: Treatment and Complications
article

Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms

R Rautio, Ángel Ferrario, Guillaume Bellanger, G Boulouis, Thanh N. Nguyen, Giancarlo Salsano, Maurizio Fuschi, Zachary A. Abecassis, A. Biondi, Fortunato Di Caterino, Oktay Algın, Alessandro Sgreccia, C Papagiannaki, Francesco Causin, Motaz Daraghma, K Premat, Matias Sinisalo, A Hassan, Claudia Rollo, М.B. Vyval, Sergio Lucio Vinci, J Cooper, Zhe Ji, Eytan Raz, Tao Hong, Lucio Castellan, Yan-Lin Li, Julien Burel, Sophia Hohenstatt, Thibault Agripnidis, Andrea M. Romi, Khawaja Muhammad Baqir Hassan, Caroline Chung, Maria Ruggiero, M Piano, Luigi Bellini, Antonio Armando Caragliano, Riccardo Russo, Reid M Gooch, Adrien Guenego, Vitor Mendes Pereira, Mauro Bergui, Luca Scarcia, Ajit S. Puri, Umair Rasheed, Lisa Saleille, Orabi Hajjeh, Joseph Domenico Gabrieli, Richard Bibi, Elvis Lafe, Francesco Capasso, Eimad Shotar, A. Pedicelli, Joanna W. K. Ho, Michael R. Levitt, Adam A. Dmytriw, Anna Luisa Kuhn, Kate Carroll, Christophe Cognard, Max Wintermark, Nourou Dine Adeniran Bankole, Frédéric Clarençon, Markus A. Möhlenbruch, Takeshi Morimoto, Alexis Guedon, Mohamad Abdalkader, Andrea M. Alexandre, Jasmeet Singh, Fumihiro Sakakibara, the CRETA Investigators, Oded Goren, Valerio Da Ros, Arturo Consoli, Virginia Pujol Lereis, Raoul Pop, Chirag D. Gandhi, Vivek Yedavalli, Marios Psychogios, Aman B. Patel, Stavropoula I. Tjoumakaris, Erwah Kalsoum, Pascal Jabbour, Davide Simonato, Peter Sporns
article en

Abstract

Flow diverters (FDs) are increasingly used for cerebral aneurysms, including distal anterior cerebral artery (DACA) aneurysms, but comparative data between devices in this challenging location are limited. To compare the safety and efficacy of Pipeline, Silk Vista Baby (SVB), and FRED Jr. FDs for unruptured DACA aneurysms and identify predictors of complete occlusion. We retrospectively analyzed 166 patients treated with FDs at 39 centers in 14 countries (2018–2022) from the CRETA registry. Outcomes included aneurysm occlusion (O’Kelly–Marotta [OKM] scale), complications, retreatment, modified Rankin Scale (mRS) scores, and independent predictors of complete occlusion using multivariable Cox regression. Aneurysms were predominantly saccular and located on the pericallosal artery. Complete occlusion (OKM D) was achieved in 73%, and neck remnants (OKM C) in 12%, with no differences across devices. Ischemic complications occurred in 11% (mostly asymptomatic), hemorrhagic complications in 5%, and in-stent stenosis in 17%. Retreatment was performed in 1.3%. At last follow-up, 98% had mRS ≤ 2. Independent predictors of complete occlusion were female sex (HR 1.85), asymptomatic presentation (HR 1.79), smaller aneurysm neck (HR 0.83/mm), radial access (HR 2.20), and aspirin plus ticagrelor therapy (HR 1.84); device type was not predictive. Pipeline, SVB, and FRED Jr. FDs show similar safety and efficacy for unruptured DACA aneurysms. Complete occlusion is influenced by clinical and procedural factors, supporting individualized device selection.

Neurological SciencesVol. 47(3)
Boston University (US), University of Rome Tor Vergata (IT), Brigham and Women's Hospital (US), St. Michael's Hospital (CA), Westchester Medical Center (US), The University of Texas MD Anderson Cancer Center (US), Harvard University (US), University of Padua (IT), Johns Hopkins University (US), Ankara University (TR), Inserm (FR), University of Massachusetts Chan Medical School (US), Capital Medical University (CN), Université de Versailles Saint-Quentin-en-Yvelines (FR), University of Washington (US), Heidelberg University (DE), Thomas Jefferson University Hospital (US), Kwong Wah Hospital (CN), Lahore General Hospital (PK), Turku University Hospital (FI), Erasmus Hospital (BE), University Hospital Heidelberg (DE), University Hospital of Basel (CH), Agostino Gemelli University Polyclinic (IT), Johns Hopkins Bayview Medical Center (US), Sorbonne Université (FR), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), NYU Langone Health (US), Assistance Publique Hôpitaux de Marseille (FR), Massachusetts General Hospital (US), Centre Hospitalier Universitaire de Besançon (FR), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Assistance Publique – Hôpitaux de Paris (FR), Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (AR), Clinical Investigation Center Plurithematic Tours (FR), Oxford Centre for Computational Neuroscience (GB), Azienda Ospedaliero-Universitaria Careggi (IT), Hôpital Lariboisière (FR), Pitié-Salpêtrière Hospital (FR), Policlinico Universitario di Catania (IT), Hôpitaux Universitaires Henri-Mondor (FR), Valley Baptist Medical Center (US), Azienda-Unita' Sanitaria Locale Di Cesena (IT), Hôpital Purpan (FR), Azienda Ospedaliera Universitaria Policlinico "G. Martino" (IT), National Academy of Medical Sciences of Ukraine (UA), Stadtspital Waid (CH), Science Oxford (GB), Ospedale Policlinico San Martino (IT), Oxford University Hospitals NHS Trust (GB), Policlinico San Matteo Fondazione (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Hôpital Foch (FR), Neurological Surgery (US), Hôpital de la Timone (FR), Geisinger Health System (US), Université de Rouen Normandie (FR), Université de Strasbourg (FR), Hyogo University (JP)
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Intracranial Aneurysms: Treatment and Complications
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