Multicenter comparative analysis of FRED-X, pipeline shield, and surpass evolve in treating intracranial aneurysms

Background In recent years, newer flow diverters have been developed with surface modification and varying wire densities. Our study evaluated outcomes among three newer generation flow diverter devices, FRED-X, PED Shield and Surpass Evolve. Methods This was a retrospective study of patients from five participating institutions across the United States. Patients who underwent flow diversion of intracranial aneurysms using the FRED-X, PED Shield or Surpass Evolve between February 2022 and September 2024 were included. Outcomes of interest were technical success, angiographic occlusion and in-stent stenosis (ISS). Results Among 447 patients with 452 aneurysms, adjunct device use was highest with Surpass Evolve (36.4%) versus PED Shield (15.7%) and FRED-X (6.4%) ( p < .001). Good wall apposition after angioplasty/stenting was most frequent with Surpass Evolve (32.3%) versus PED Shield (13.7%) and FRED-X (4.5%) ( p < .001). At six months, complete occlusion was achieved in 69.3% (PED Shield), 63.6% (FRED-X), and 58% (Surpass Evolve) ( p = .254). ISS rates were comparable at six months ( p = .826). At 12 months, complete occlusion was observed in 78.9% of PED Shield, 68.4% of FRED-X, and 64.5% of Surpass Evolve aneurysms. Most ISS cases at 12 months were mild. Kaplan-Meier analysis showed no significant difference in occlusion rates ( p = .914). Conclusions Flow diversion using FRED-X, PED Shield and Surpass Evolve resulted in comparable rates of angiographic occlusion and ISS. However, adjunctive devices were more commonly needed with Surpass Evolve.