Importance: Brain aneurysms have traditionally been treated with surgical clipping or endovascular coiling techniques. With these modalities, many large or complex aneurysms remain difficult to treat. A new option, flow diversion, is now available to treat aneurysms.
Objective: To summarize the clinical progression of flow diversion technology, from an experimental treatment to a commonly used method to treat large or complex aneurysms.
Evidence review: References for this topical review were identified by searches of PubMed and GoogleScholar between January 2000 and January 2016. The search terms aneurysm, flow diverter, stent, pipeline, FRED, SURPASS, SILK, flow diversion, and endovascular were used. Ongoing clinical trials were identified using the same search terms in the clinicaltrial.gov registry. Attention was focused on current indications, rates of complications, and areas of ongoing study in randomized clinical trials.
Findings: Flow diversion is a treatment approved by the US Food and Drug Administration for brain aneurysms that redirects blood flow away from the aneurysm, thereby promoting growth of a new endothelial lining across the aneurysm opening. Cure rates with this technology are high and complication rates are low.
Conclusions and relevance: Flow diversion is a disruptive technology that has changed the way many brain aneurysms are treated. It is currently a preferred treatment option for large or giant wide-necked proximal internal carotid artery aneurysms. Ongoing randomized studies will help to more rigorously determine the efficacy of flow diversion.