Evidence map›Paper›PMID 41706217›Full record

ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026

Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms.

Hamza Adel Salim, Luca Scarcia, Frédéric Clarençon, Orabi Hajjeh, Motaz Daraghma, Davide Simonato, Yan-Lin Li, Eimad Shotar, Kevin Premat, Pascal Jabbour and 81 more

Abstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
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Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

91 authors.

Hamza Adel SalimDepartment of Neuroradiology, MD Anderson Medical Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030, USA. hamza.sleeem@gmail.com.
Luca ScarciaNeuroradiology Unit, Henri Mondor Hospital, Creteil, France.
Frédéric ClarençonDepartment of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, Bd de L'Hôpital, APHP, 47, Paris, France.
Orabi HajjehDepartment of Neuroradiology, MD Anderson Medical Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030, USA.
Motaz DaraghmaDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Davide SimonatoDepartment of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Nuffield, Oxford, UK.
Yan-Lin LiDepartment of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Nuffield, Oxford, UK.
Eimad ShotarDepartment of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, Bd de L'Hôpital, APHP, 47, Paris, France.
Kevin PrematDepartment of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, Bd de L'Hôpital, APHP, 47, Paris, France.
Pascal JabbourDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Stavropoula I TjoumakarisDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Reid M GoochDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Marios PsychogiosDiagnostic and Interventional Neuroradiology, Universitätsspital Basel, Basel, Switzerland.
Nikos NtouliasDiagnostic and Interventional Neuroradiology, Universitätsspital Basel, Basel, Switzerland.
Peter SpornsDepartment of Radiology and Neuroradiology, Stadtspital, Zürich, Switzerland.
Ajit S PuriDivision of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
Jasmeet SinghDivision of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
Anna Luisa KuhnDivision of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
Ameer E HassanDepartment of Neurology, Valley Baptist Medical Center, University of Texas Rio Grande Valley, Harlingen, TX, USA.
Oktay AlginDepartment of Radiology, Ankara University, Ankara, Turkey.
Markus A MöhlenbruchInterventional Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Sophia HohenstattInterventional Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Riccardo RussoDepartment of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città Della Salute E Della Scienza Hospital, Turin, Italy.
Mauro BerguiDepartment of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città Della Salute E Della Scienza Hospital, Turin, Italy.
Oded GorenDepartment of Neurosurgery, Geisinger Health System, Danville, PA, USA.
Matthew J KoleDepartment of Neurosurgery, Geisinger Health System, Danville, PA, USA.
Nourou Dine Adeniran BankoleClinical Investigation Center (CIC), 1415, INSERM, Teaching Hospital of Tours, Tours, France.
Richard BibiClinical Investigation Center (CIC), 1415, INSERM, Teaching Hospital of Tours, Tours, France.
Gregoire BoulouisClinical Investigation Center (CIC), 1415, INSERM, Teaching Hospital of Tours, Tours, France.
Takeshi MorimotoDepartment of Data Science, Hyogo Medical University, Nishinomiya, Japan.
Fumihiro SakakibaraDepartment of Data Science, Hyogo Medical University, Nishinomiya, Japan.
Raoul PopInterventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France.
Ciprian JuravleInterventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France.
Joanna W K HoDepartment of Neurosurgery, Kwong Wah Hospital, Hong Kong, China.
Ãngel FerrarioServicio de Neurorradiologa Intervencionista, Fleni, Buenos Aires, Argentina.
Virginia Pujol LereisDepartment of Neurology, Vascular Neurology Division, Institute of Neurological Research, FLENI, Buenos Aires, Argentina.
Jared CooperDepartment of Neurosurgery, Westchester Medical Center, New York, USA.
Chirag D GandhiDepartment of Neurosurgery, Westchester Medical Center, New York, USA.
Giancarlo SalsanoUO Neuroradiologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Lucio CastellanUO Neuroradiologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Arturo ConsoliDiagnostic and Interventional Neuroradiology Department, Foch Hospital, Suresnes, France.
Alessandro SgrecciaDiagnostic and Interventional Neuroradiology Department, Foch Hospital, Suresnes, France.
Eytan RazDepartment of Radiology and Neurosurgery, NYU Langone Health, New York, NY, USA.
Charlotte ChungDepartment of Radiology and Neurosurgery, NYU Langone Health, New York, NY, USA.
Julien BurelDepartment of Radiology, Rouen University Hospital, Rouen, France.
Chrysanthi PapagiannakiDepartment of Radiology, Rouen University Hospital, Rouen, France.
Umair RasheedDepartment of Neuroradiology, Lahore General Hospital, Lahore, Pakistan.
Khawaja Muhammad Baqir HassanDepartment of Neuroradiology, Lahore General Hospital, Lahore, Pakistan.
Hong TaoDepartment of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Zhe JiDepartment of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Riitta RautioDepartment of Interventional Radiology, Turku University Hospital, Turku, Finland.
Matias SinisaloDepartment of Interventional Radiology, Turku University Hospital, Turku, Finland.
Maria RuggieroNeuroradiology Unit, AUSL Romagna, Cesena, Italy.
Elvis LafeNeuroradiology Unit, AUSL Romagna, Cesena, Italy.
Valerio Da RosDepartment of Biomedicine and Prevention, University Hospital of Rome Tor Vergata, Rome, Italy.
Luigi BelliniDepartment of Biomedicine and Prevention, University Hospital of Rome Tor Vergata, Rome, Italy.
Joseph Domenico GabrieliNeuroradiology Unit, Policlinico Universitario Di Padova, Padua, Italy.
Francesco CausinNeuroradiology Unit, Policlinico Universitario Di Padova, Padua, Italy.
Michael R LevittDepartment of Neurological Surgery, University of Washington, Seattle, WA, USA.
Kate CarrollDepartment of Neurological Surgery, University of Washington, Seattle, WA, USA.
Zachary AbecassisDepartment of Neurological Surgery, University of Washington, Seattle, WA, USA.
Antonio Armando CaraglianoNeuroradiology Unit, AOU Policlinico G. Martino, Messina, Italy.
Sergio Lucio VinciNeuroradiology Unit, AOU Policlinico G. Martino, Messina, Italy.
Guillaume BellangerService de Neuroradiologie Interventionnelle Et Diagnostique, Hôpital Purpan CHU Toulouse, Toulouse, France.
Christophe CognardService de Neuroradiologie Interventionnelle Et Diagnostique, Hôpital Purpan CHU Toulouse, Toulouse, France.
Gaultier MarnatNeuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
Lisa SaleilleNeuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
Nicola LimbucciInterventional Neurovascular Unit, A.O.U. Careggi, Florence, Italy.
Francesco CapassoInterventional Neurovascular Unit, A.O.U. Careggi, Florence, Italy.
Mariangela PianoNeuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Claudia RolloNeuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Alexis GuedonDepartment of Neuroradiology, AP-HP Nord, Hôpital Lariboisière, Paris, France.
Francesco ArpaiaDepartment of Neuroradiology, AP-HP Nord, Hôpital Lariboisière, Paris, France.
Andrea RomiNeuroradiology Unit, IRCCS Policlinico San Matteo, Pavia, Italy.
Fortunato Di CaterinoDepartment of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France.
Alessandra BiondiDepartment of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France.
Erwah KalsoumNeuroradiology Unit, Henri Mondor Hospital, Creteil, France.
Mykola VyvalResearch and Practical Centre for Endovascular Neuroradiology, NAMS of Ukraine, Kiev, Ukraine.
Adrien GuenegoDepartment of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Than NguyenDepartment of Radiology and Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
Mohamad AbdalkaderDepartment of Radiology and Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
Thibault AgripnidisNeuroradiology Department, University Hospital Timone, AP-HM, 13005, Marseille, France.
Aman B PatelNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
Vitor Mendes PereiraNeurovascular Centre & RADIS Lab, St. Michael's Hospital, University of Torontoand, Toronto Metropolitan University, Toronto, Canada.
Maurizio FuschiDepartment of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Nuffield, Oxford, UK.
Alessandro PedicelliUOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
Vivek YedavalliDepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Max WintermarkDepartment of Neuroradiology, MD Anderson Medical Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030, USA.
Andrea M AlexandreUOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
Adam A DmytriwNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
CRETA Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFlow diverters (FDs) are increasingly used for cerebral aneurysms, including distal anterior cerebral artery (DACA) aneurysms, but comparative data between devices in this challenging location are limited.

objectiveTo compare the safety and efficacy of Pipeline, Silk Vista Baby (SVB), and FRED Jr. FDs for unruptured DACA aneurysms and identify predictors of complete occlusion.

methodsWe retrospectively analyzed 166 patients treated with FDs at 39 centers in 14 countries (2018–2022) from the CRETA registry. Outcomes included aneurysm occlusion (O’Kelly–Marotta [OKM] scale), complications, retreatment, modified Rankin Scale (mRS) scores, and independent predictors of complete occlusion using multivariable Cox regression.

resultsAneurysms were predominantly saccular and located on the pericallosal artery. Complete occlusion (OKM D) was achieved in 73%, and neck remnants (OKM C) in 12%, with no differences across devices. Ischemic complications occurred in 11% (mostly asymptomatic), hemorrhagic complications in 5%, and in-stent stenosis in 17%. Retreatment was performed in 1.3%. At last follow-up, 98% had mRS ≤ 2. Independent predictors of complete occlusion were female sex (HR 1.85), asymptomatic presentation (HR 1.79), smaller aneurysm neck (HR 0.83/mm), radial access (HR 2.20), and aspirin plus ticagrelor therapy (HR 1.84); device type was not predictive.

conclusionPipeline, SVB, and FRED Jr. FDs show similar safety and efficacy for unruptured DACA aneurysms. Complete occlusion is influenced by clinical and procedural factors, supporting individualized device selection.

Indexed as

Anterior Cerebral ArteryEndovascular ProceduresIntracranial AneurysmStentsAgedFemaleHumansMaleMiddle AgedRegistriesRetrospective StudiesTreatment OutcomeAneurysm occlusionDistal anterior cerebral artery aneurysmsEndovascular treatmentFlow diverter devices

Identifiers

PMID41706217
PMCPMC12916520

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