Neurointervention · IR Playbook

Flow-Diverter Placement for Intracranial Aneurysm (FD)

Flow-diverter placement is the deployment of a densely braided, low-porosity stent across the neck of an intracranial aneurysm within the parent artery, reconstructing the diseased segment rather than filling the sac. It works by reducing inflow jet velocity and shear across the neck so that intra-aneurysmal blood stagnates and thromboses, while the braid acts as a scaffold for neointimal growth that seals the neck over weeks to months; every distinctive complication follows from this delayed, thrombosis-dependent mechanism, namely persistent rupture risk in the first month, dependence on dual antiplatelet therapy, and side-branch or perforator compromise where the braid crosses an origin. In the PUFS trial of large and giant wide-necked internal carotid artery aneurysms, complete occlusion rose from 73.6 percent at 180 days to 86.8 percent at 1 year and 95.2 percent at 5 years with no aneurysm recurrence, at a cost of 5.6 percent major ipsilateral stroke or neurological death. Real-world safety is less favourable: the IntrePED registry of 793 patients reported combined neurological morbidity and mortality of 8.4 percent, rising to 16.4 percent for posterior circulation aneurysms.

What this playbook covers

The full playbook is part of a RadioQBank subscription. See plans.