Predictive factors of delayed braid deformation in DFT flow diverters

Background Concerns have arisen regarding flow diverter braid deformation (FDBD), particularly with last-generation platinum drawn-filled tube (DFT) wire devices. Braid deformation is likely multifactorial, influenced by patient characteristics, device selection, and procedural factors, yet no clinical analysis has systematically identified predictive factors. We conducted a study to determine the incidence, patterns, and predictors of braid deformation with these devices. Methods Consecutive intracranial aneurysms treated with various flow diverters (FDs) constructed with DFT wires between June 2018 and June 2024 were included. High-resolution cone-beam CT with diluted contrast (vasoCT) and angiograms were reviewed to identify and classify FDBD following international consensus definitions. Patient, aneurysm, anatomy, procedural, and FD characteristics were retrieved and analyzed using univariate and multivariable analyses. Results A total of 102 patients were included. FDBD was observed in 28 patients (27%), comprising 41 deformations. Three independent predictors of FDBD were identified: short distal landing zone (aOR 0.80, 95% CI 0.63 to 0.98; P=0.04), FD proximal oversizing (aOR 40.05, 95% CI 5.14 to 405.23; P<0.01), and younger age (aOR 0.93, 95% CI 0.88 to 0.98; P<0.01). Internal carotid artery aneurysms were also associated with FDBD in the univariate analysis (P<0.05). Conclusion FDBD with DFT FDs is a frequent phenomenon observed in about 1/4 cases, associated with symptomatic complications but without affecting permanent morbidity. Patient age and technical factors such as short landing zone and FD oversizing were independent predictors of FDBD. This analysis may help to guide operator decisions when using DFT FDs and support future research in this field.