Abstract Background and aims Flow diverters (FDs) are a key endovascular treatment for intracranial aneurysms (IAs). New surface-coated FDs aim to reduce thrombogenicity and enhance safety, but clinical evidence remains limited. This study compares nationwide in-hospital outcomes of aneurysm treatments using coated versus uncoated FDs in Germany. Methods A retrospective cohort analysis using 2022 German nationwide administrative data (ICD-10-GM, OPS) compared inhospital outcomes from endovascular treatments using coated versus uncoated FDs. Primary endpoints were functional independence (discharge disposition), poor functional outcome (NIS–Subarachnoid Hemorrhage Outcome Measure) and mortality. Inverse probability–weighted Poisson regression with cluster-robust standard errors at the center level was used for adjustment. Secondary endpoints included hospital stay duration, ventilation time, and costs. Results Among 1,397 FD-treated IAs (53% coated, 47% uncoated; 83.8% unruptured), coated FDs in unruptured IAs were associated with better in-hospital functional outcomes (discharge home: 96.5% vs. 92.4%, P = 0.03), and numerically fewer poor outcomes (NIS-SOM: 1.4% vs. 3.3%; RR 0.504, 95% CI 0.185–1.375) and lower mortality (0.9% vs. 2.1%; RR 0.502, 95% CI 0.187–1.451). Coated FDs were also linked to shorter hospital stays (P = 0.001), reduced prolonged ventilation (P = 0.032). In ruptured IAs, outcomes did not differ significantly between groups. Conclusions Nationwide data suggest coated FDs may offer improved safety outcomes for unruptured IAs at hospital discharge, whereas no benefit was observed in ruptured cases. Further randomized studies including comparison of long-term outcomes are needed for confirmation. Conflict of interest nothing to disclose.
Imerlishvili et al. (Fri,) studied this question.