Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

Author:

Waqas Muhammad12ORCID,Dossani Rimal H12,Alkhaldi Modhi3,Neveu Jocelyn4,Cappuzzo Justin M12,Lim Jaims12,Khan Asham12,Lazarov Victoria4,Monteiro Andre12,Davies Jason M12567ORCID,Siddiqui Adnan H12678,Levy Elad I12678ORCID

Affiliation:

1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

2. Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA

3. Depratment of Neurology, Abdulrhman Bin Faisal University, Imam, Saudi Arabia

4. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

5. Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

6. Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA

7. Jacobs Institute, Buffalo, NY, USA

8. Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

Abstract

Introduction The Flow Redirection Endoluminal Device (FRED; MicroVention) is a dual-layered flow diverter used for the treatment of intracranial aneurysms. The objective of this systematic review was to compile device-related safety and effectiveness data. Methods The literature from January 1, 2013 to April 30, 2021 was searched for studies describing use of the FRED for intracranial aneurysm treatment irrespective of aneurysm location and morphology. The review included anterior and posterior circulation ruptured and unruptured saccular, fusiform or dissection, and blister aneurysms. MeSH terms related to “flow re-direction endoluminal device” and “FRED for aneurysms” were used. Data related to indication, complications, and rates of aneurysm occlusion were retrieved and analyzed. Results Twenty-two studies with 1729 intracranial aneurysms were included in this review. Overall reported morbidity was 3.9% (range 0–20%). Overall procedure-related mortality was 1.4% (range 0–6%). Complication rates fell into 5 categories: technical (3.6%), ischemic (3.8%), thrombotic or stenotic (6%), hemorrhagic (1.5%), and non-neurological (0.8%). The aneurysm occlusion rate between 0 and 3 months (reported in 11 studies) was 47.8%. The occlusion rate between 4 and 6 months (reported in 14 studies) was 73.8%. Occlusion rates continued to increase to 75.1% at 7–12 months (reported in 10 studies) and 86.6% for follow-up beyond 1 year (reported in 10 studies). Conclusion This review indicated that the FRED is a safe and effective for the treatment of intracranial aneurysms. Future studies should directly compare the FRED with other flow diverters for a better understanding of comparative safety and effectiveness among the different devices.

Publisher

SAGE Publications

Subject

Immunology

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