Predictors of In-Stent Stenosis After Flow Diversion of Intracranial Aneurysms Using the FRED-X Device: A Multicenter Analysis of 6-month and 12-Month Outcomes.
Publication/Presentation Date
9-24-2025
Abstract
BACKGROUND AND OBJECTIVES: In-stent stenosis (ISS) occurs in approximately 0% to 55.3% of cases after flow diversion. The Flow Redirection Endoluminal Device-X (FRED-X) is a newer generation flow diverter with surface modifications. Our study identifies predictors of ISS after flow diversion using the FRED-X.
METHODS: This was a multicenter retrospective study of patients who underwent flow diversion of an intracranial aneurysm using the FRED-X device between February 2022 and February 2024. Multivariate logistic regression was used to analyze for predictors of ISS at 6-month or 12-month follow-up.
RESULTS: One fifty-four patients with 161 aneurysms underwent flow diversion with 164 FRED-X devices. At 6 months, 15.1% of cases (n = 21) developed ISS. Overall, 61.9% of patients (n = 13) developed mild ISS, 33.3% (n = 7) patients had moderate ISS, and 4.7% (n = 1) patients had severe ISS. On multivariate regression, cardiovascular disease and FRED-X stent length were associated with 6.25-fold (95% CI: 1.19-32.86) and 1.09-fold (95% CI: 1.00-1.20) higher odds of developing ISS at 6 months, whereas aneurysm width was associated with decreased odds of developing ISS (odds ratio: 0.61, 95% CI: 0.38-0.88). At 12 months, 12.0% of cases (n = 10) developed ISS. Overall 80% of this cohort (n = 8) developed mild ISS, whereas 1 patient each developed moderate and severe ISS.
CONCLUSION: Our study identified cardiovascular disease, smaller aneurysm width, and stent length as independent predictors of ISS after flow diversion using the FRED-X. Patients with ISS were asymptomatic and did not require retreatment. Further prospective studies are necessary to validate these findings.
ISSN
2332-4260
Published In/Presented At
Roy, J. M., Musmar, B., Patil, S., Sizdahkhani, S., Atallah, E., Momin, A., Paul, A., Field, N. C., Zhang, Y., Burkhardt, J. K., Kühn, A. L., Puri, A., Levy, E., Gooch, M. R., Jabbour, P., Rosenwasser, R. H., & Tjoumakaris, S. I. (2025). Predictors of In-Stent Stenosis After Flow Diversion of Intracranial Aneurysms Using the FRED-X Device: A Multicenter Analysis of 6-month and 12-Month Outcomes. Operative neurosurgery (Hagerstown, Md.), 10.1227/ons.0000000000001725. Advance online publication. https://doi.org/10.1227/ons.0000000000001725
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
40991248
Department(s)
Administration and Leadership
Document Type
Article