Flow Diversion

Abstract

As documented by the PUFS trial and various single and multi-institutional registries, FDT (flow diverter therapy), in contrast to the often limited results of coil-endosaccular, offers high rates of complete and durable occlusion of large, complex-neck aneurysms, with comparatively lower rates of treatment-associated major morbidity and mortality, with the added benefit of relief from mass effect. Experience from the PREMIER trial and outside the United States suggests these benefits may be generalized to a larger population of cerebral aneurysms and, thus, in the future will likely play an ever larger role in aneurysm treatment. Nevertheless, several issues regarding their use will require additional experience and further evaluation: the ideal number of devices (degree of coverage, critical porosity) necessary for definitive aneurysm occlusion, the necessity and duration of antiplatelet coverage, the role of antiplatelet testing, indications for adjunctive coiling, and the spectrum of aneurysm morphologies and locations preferentially addressed by FDT.