Comparison of Lattice Flow Diverter and Pipeline Embolization Device in Unruptured Intracranial Aneurysms: A Real-World, Propensity Score Matching Study

BACKGROUND AND OBJECTIVES: Flow diverters (FDs) have been increasingly used in treating unruptured intracranial aneurysms (UIAs). However, comparative studies between the novel lattice flow diverter (LFD) and other FDs are limited. Our study aimed to compare outcomes of LFD and the pipeline embolization device (PED) for UIAs using propensity score matching (PSM). METHODS: Patients with UIAs treated with LFD or PED between August 2023 and November 2024 were included. PSM was performed to adjust for age, sex, comorbidities, ischemic stroke history, smoking status, alcohol abuse, preoperative modified Rankin Scale scores, history of multiple aneurysms, aneurysm characteristics, adjunctive coiling, and angiographic follow-up duration. Perioperative complications and clinical and angiographic outcomes were compared after matching. RESULTS: A total of 99 patients treated by LFD and 187 patients treated by PED were included. Compared with the PED group, the LFD group had fewer females and more patients with a history of multiple aneurysms, wider aneurysm necks, shorter stent lengths, and lower rates of in-stent stenosis (ISS) (stenosis > 50%). After PSM, 55 matched pairs were analyzed. The LFD group demonstrated significantly lower ISS rates (1.8% vs 14.5%, P = .037), with no significant differences in perioperative complications, the complete occlusion rate at the median 216-day angiographic follow-up (87.3% vs 85.5%, P > .999), or favorable outcomes (96.4% vs 94.5%, P > .999) compared with the PED group. CONCLUSION: The mechanical balloon-based LFD with surface modification showed a lower ISS rate and comparable perioperative outcomes, short-term occlusion rates, and clinical prognosis compared with PED. The advantages brought by the Innovation of LFD warrant further validation through long-term randomized controlled trials.