Document Type
Article
Publication Date
2-18-2026
Abstract
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.
Recommended Citation
Salim, Hamza Adel; Scarcia, Luca; Clarençon, Frédéric; Hajjeh, Orabi; Daraghma, Motaz; Simonato, Davide; Li, Yan-Lin; Shotar, Eimad; Premat, Kevin; Jabbour, Pascal; Tjoumakaris, Stavropoula; Gooch, Michael R.; 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, Ãngel; 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.; and CRETA Investigators, "Comparative Safety, Efficacy, and Predictors of Complete Occlusion of Flow Diverter Devices in the Treatment of Unruptured Distal Anterior Cerebral Artery Aneurysms" (2026). Department of Neurosurgery Faculty Papers. Paper 293.
https://jdc.jefferson.edu/neurosurgeryfp/293
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
41706217
Language
English
Comments
This article is the author's final published version in Neurological Sciences, Volume 47, Issue 3, February 2026, Article Number 270.
The published version is available at https://doi.org/10.1007/s10072-026-08869-w. Copyright © The Author(s) 2026.