The flow diverter is becoming a standard device for treating cerebral aneurysms. The aim of this in vitro study was to evaluate the impact of flow complexity on the effectiveness of flow diverter stents in a cerebral aneurysm model. The flow pattern of a carotid artery was decomposed into harmonics to generate four flow patterns with different pulsatility indexes ranging from 0.72 to 1.44. The effect of flow diverters on the aneurysm was investigated by injecting red dye or erythrocytes as markers. The recorded images were postprocessed to evaluate the maximum filling of the aneurysm cavity and the washout time. There were significant differences in the cutoff flows between the markers, linked to the flow complexity. Increasing the pulsatility index altered the performance of the flow diverter. The red dye was more sensitive to changes in flow than the red blood cell markers. The flow cutoff depended on the diverter design and the diverter deployment step was crucial for reproducibility of the results. These results strongly suggest that flow complexity should be considered when selecting a flow diverter. Flow diverters are common devices for treating large or complex intracranial aneurysms. As the mechanisms underlying aneurysm occlusion are still not fully understood, the choice of flow diverter is mainly empirical and based on the physician's own experience 1,2. Outcomes range from complete or partial occlusion after varying periods to lack of thrombosis or even haemorrhage 3,4. The factors responsible for occlusion following flow diverter placement are still under debate 3,5. Analysis of the flow inside large aneurysms reveals that, by contrast with small aneurysms where flow is similar to the parent vessel, the flow pattern can be markedly altered 6. Recent studies show that flow complexity is a key factor in flow diverter performance. Computational fluid dynamics (CFD) simulations showed that flow reduction following flow diverter treatment was more noticeable during diastole than systole and that flow diverter performance was related to the flow pattern 7,8. Although blood flow complexity can be fully described using a Fourier decomposition into harmonics, these values are not commonly used in the medical field 9. Instead, the pulsatility index, which can be directly assessed from Doppler or magnetic resonance imaging (MRI) examinations, is more widely used to describe the complexity of patient blood flows 10. The pulsatility index varies within the cerebral arterial tree and within the same artery in different patients, reflecting the diversity of flow patterns that can be encountered within the vessels altered by aneurysms 11,12. Different outcomes are therefore observed when the same flow diverter is used in situations of different flow patterns associated with vessel geometry and position in the cerebral arterial tree, and the physiological state and activity of the patient 13,14. In addition, flow diverter design, including the number of layers, porosity, number of holes, weave angle, wire diameter, a...