Observations on the Efficacy and Safety of FRED Jr Flow Diverter for the Treatment of Intracranial Unruptured Distal Aneurysms: A Single-Center Experience
Year: 2025
Type: article
Study design: Observational Study
Abstract: ABSTRACT BACKGROUND AND PURPOSE: Large-scale data on FRED™ Jr flow diversion for aneurysms in distal M2/M3 MCA and A2/A3 ACA segments are limited. This study assessed the safety and efficacy of FRED™ Jr for these unruptured aneurysms, focusing on outcomes of covered vessels and identifying predictors of incomplete occlusion. MATERIALS AND METHODS: We retrospectively reviewed 56 consecutive patients with 56 unruptured distal MCA/ACA aneurysms (mean size 3.60mm) treated with FRED™ Jr. Endpoints included aneurysm occlusion (O9Kelly-Marotta scale), clinical outcomes (mRS), and in-stent stenosis. Multivariable logistic regression was used to identify predictors of incomplete occlusion. RESULTS: Device deployment was 100% successful, with optimal immediate apposition in 82.1%. Intraprocedural thrombosis occurred in 3 patients (5.4%), all resolving without neurological deficits. At follow-up, 10 patients (17.8%) experienced asymptomatic (mRS=0) adverse imaging findings, including mild-moderate in-stent stenosis (n=7) and jailed branches occlusion (n=3). Complete/nearcomplete occlusion rates were 73.2% at 6 months and 85.7% at 12 months. Independent predictors of incomplete occlusion were jailed branches crossing the aneurysm neck (OR=5.5, 95%CI 1.4-54.3; p=0.02) and incomplete stent apposition (OR=9.6, 95%CI 2.560.8; p=0.002). CONCLUSIONS: FRED™ Jr for distal MCA/ACA aneurysms demonstrates high technical success and favorable occlusion rates with an acceptable safety profile. However, asymptomatic in-stent stenosis or branch occlusion occurred in 17.8% of cases. Incomplete stent apposition and the presence of jailed branches at the aneurysm neck are significant independent risk factors for treatment failure, highlighting the need for meticulous procedural planning. ABBREVIATIONS: OKM＝O’Kelly–Marotta grading scale.
DOI: 10.3174/ajnr.a9067
Authors: Qi Tian, Songzi Kou, Shuailong Shi, Shuhai Long, Yukun Hou, Minhao Chen, Ji Ma, Jie Yang, Ye Wang, Li Tengfei
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4415564149