Incidence and Predictors of Braid Deformations following Aneurysm Treatment with the DERIVO(2heal) Flow Diverter: A Single-Center Experience

BACKGROUND AND PURPOSE: Flow diverters (FDs) are established endoluminal devices for intracranial aneurysm treatment. Concerns have been raised regarding braid deformations (BDs) affecting braid stability. We investigated the incidence and potential predictors of BDs in DERIVO and DERIVO2heal FDs. MATERIALS AND METHODS: This retrospective single-center observational study included consecutive patients undergoing intracranial aneurysm treatment with a DERIVO or DERIVO2heal FD between 2016 and 2025. BDs were assessed applying recently proposed ESMINT endorsed classification guidelines. Clinical outcomes, aneurysm occlusion, and in-stent stenosis (ISS) were assessed. Multivariable logistic regression analysis was performed to identify independent predictors of BDs. RESULTS: A total of 147 procedures treating 189 aneurysms were included. BDs occurred in 19/147 procedures (12.9%), with no significant difference between the DERIVO (13.8%) and DERIVO2heal (11.9%; p=0.75). Most BDs (24/28 [85.7%]) were detected at 6-months follow-up. Fish-mouthing and braid hump were the most frequent categories, detected in 8/147 (5.4%) devices. Younger patient age (aOR=0.95, 95% CI 0.91–0.99; p=0.01) and incomplete postprocedural wall apposition (aOR=11.12, 95% CI 2.67–49.30; p<0.01) were independent predictors of BDs. Moreover, BDs were significantly associated with higher rates of ISS (BDs vs non-BDs, 89.5% vs 13.3%, p=<0.01). Aneurysm occlusion rates (p=0.95) and ischemic complications at 6 months (p=0.70) did not differ between patients with and without BDs. CONCLUSION: BDs occurred in 13% of patients, without significant difference between the two device generations. Younger patient age and incomplete wall apposition after deployment seem to negatively affect short–term device stability. No negative impact on clinical outcome and occlusion rates was detected.