Introduction: Flow diversion is an increasingly common option for the treatment of intracranial aneurysms. Flow diverters (FDs) exclude aneurysms from circulation by inducing stasis and eventual aneurysm thrombosis and device endothelialization. FDs with antithrombotic surface modifications, including the Flow Re-Direction Endoluminal Device X (FRED X), have advanced this technology to address concerns with thrombogenicity.
Methods: Data for consecutive patients undergoing placement of FRED X at a single urban academic medical center From January 2022 through October 2024 were prospectively collected, including demographics, risk factors, location and size of aneurysm, complications, obliteration and revision rates, and clinic/angiographic follow up.
Results: There were 75 total FRED X treatments (68 patients), 91.7% female and an average age of 55.4± 14.6 years. Most aneurysms (82.7%, 62/75) were in the internal carotid artery (ICA), with 5.3% (4/75) in the posterior circulation. 18.7% (14/75) had previously ruptured. Average aneurysm size was 7.4±6.5 mm. 14.7% (11/75) of treatments were on aneurysms previously treated with coils, clip, or other flow diverter. Median FRED X width was 4mm with median length and flow diverting segment 18mm and 12mm, respectively. 54.7% of patients were discharged on aspirin/ticagrelor and 38.7% on aspirin/clopidogrel. There were 2 events of periprocedural thrombosis (2.7%), with intravenous cangrelor used in 9.3% of hospital stays, and 6.7% rate of bleeding complications. Mean follow up was 5.1 months. 60.4% (29/48) of those with imaging follow up revealed obliteration of the aneurysm and 9.3% (7/75) of treatments underwent later revision. There was no significant difference in the rate of obliteration with aspirin/clopidogrel vs aspirin/ticagrelor (p=0.85). 4% (3/75) involved telescoping, i.e. the placement of one flow diverter inside of another for optimal treatment.
Conclusion : Flow diversion with FRED X is a safe and effective modality for primary or adjunctive treatment of intracranial aneurysms, with a strong rate of aneurysm obliteration at follow up.
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