What question did this study set out to answer?

The aim is to compare the safety and efficacy of different flow diverters for treating unruptured DACA aneurysms and to identify predictors of complete occlusion.

February 21, 2026Open Access

Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms

Key Points

The aim is to compare the safety and efficacy of different flow diverters for treating unruptured DACA aneurysms and to identify predictors of complete occlusion.
Retrospective analysis of 166 patients treated with flow diverters
Data collected from 39 centers across 14 countries
Outcomes measured include aneurysm occlusion, complications, and functional scores
Statistical analysis including multivariable Cox regression to identify predictors
Complete occlusion achieved in 73% of cases
Complications included ischemic (11%), hemorrhagic (5%), and in-stent stenosis (17%)
98% of patients had modified Rankin Scale scores ≤ 2 at follow-up
Independent predictors of occlusion identified as female sex, asymptomatic presentation, smaller neck size, radial access, and specific dual therapy

Abstract

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. 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. 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. 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. 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.

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Cite This Study

Musmar et al. (Wed,) studied this question.

synapsesocial.com/papers/69994b88873532290d01fb09 https://doi.org/https://doi.org/10.1007/s10072-026-08869-w

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