Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms
: Salim, Hamza Adel; Scarcia, Luca; Clarençon, Frédéric; Hajjeh, Orabi; Daraghma, Motaz; Simonato, Davide; Li, Yan-Lin; Shotar, Eimad; Premat, Kevin; Jabbour, Pascal; Tjoumakaris, Stavropoula I.; Gooch, Reid M.; Psychogios, Marios; Ntoulias, Nikos; Sporns, Peter; Puri, Ajit S.; Singh, Jasmeet; Kuhn, Anna Luisa; Hassan, Ameer E.; Algin, Oktay; Möhlenbruch, Markus A.; Hohenstatt, Sophia; Russo, Riccardo; Bergui, Mauro; Goren, Oded; Kole, Matthew J.; Bankole, Nourou Dine Adeniran; Bibi, Richard; Boulouis, Gregoire; Morimoto, Takeshi; Sakakibara, Fumihiro; Pop, Raoul; Juravle, Ciprian; Ho, Joanna W. K.; Ferrario, Ángel; Lereis, Virginia Pujol; Cooper, Jared; Gandhi, Chirag D.; Salsano, Giancarlo; Castellan, Lucio; Consoli, Arturo; Sgreccia, Alessandro; Raz, Eytan; Chung, Charlotte; Burel, Julien; Papagiannaki, Chrysanthi; Rasheed, Umair; Hassan, Khawaja Muhammad Baqir; Tao, Hong; Ji, Zhe; Rautio, Riitta; Sinisalo, Matias; Ruggiero, Maria; Lafe, Elvis; Da Ros, Valerio; Bellini, Luigi; Gabrieli, Joseph Domenico; Causin, Francesco; Levitt, Michael R.; Carroll, Kate; Abecassis, Zachary; Caragliano, Antonio Armando; Vinci, Sergio Lucio; Bellanger, Guillaume; Cognard, Christophe; Marnat, Gaultier; Saleille, Lisa; Limbucci, Nicola; Capasso, Francesco; Piano, Mariangela; Rollo, Claudia; Guedon, Alexis; Arpaia, Francesco; Romi, Andrea; Di Caterino, Fortunato; Biondi, Alessandra; Kalsoum, Erwah; Vyval, Mykola; Guenego, Adrien; Nguyen, Than; Abdalkader, Mohamad; Agripnidis, Thibault; Patel, Aman B.; Pereira, Vitor Mendes; Fuschi, Maurizio; Pedicelli, Alessandro; Yedavalli, Vivek; Wintermark, Max; Alexandre, Andrea M.; Dmytriw, Adam A.
Publisher: Springer Science and Business Media LLC
: 2026
Neurological Sciences
: 270
: 47
: 3
: 1590-1874
: 1590-3478
DOI: https://doi.org/10.1007/s10072-026-08869-w
: https://doi.org/10.1007/s10072-026-08869-w
: https://research.utu.fi/converis/portal/detail/Publication/515725501
Background: 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.
Objective: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Keywords: Aneurysm occlusion; Distal anterior cerebral artery aneurysms; Endovascular treatment; Flow diverter devices.
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The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
