Treatment of 14 intracranial aneurysms with the FRED system

Abstract

The FRED system was technically easy to deploy with no procedural complications occurring in this first reported series of 14 aneurysms. The ability of the FRED system to be recaptured after partial deployment and to maintain its internal shape in tortuous vessels was demonstrated well. Long term clinical and angiographic follow-up along with prospective studies are now needed to ascertain the role of the FRED in intracranial aneurysm treatment.

Extending the Indications of Flow Diversion to Small, Unruptured, Saccular Aneurysms of the Anterior Circulation

“…Other flow diverters include Silk (Balt, Montmorency, France), Surpass (Stryker, Fremont, CA), and FRED (Microvention, Tustin, CA). 18 The Silk stent has been extensively used outside the United States, and the Surpass has recently shown promising results in a small series from Europe. 4,19,20 Initially reserved for complex, giant, and fusiform aneurysms, flow diverters are currently increasingly used in the management of small and less complex aneurysms at some institutions.…”

Editorial: Flow Re-Direction Endoluminal Device

“…No technical, ischemic, or hemorrhagic complications were noted in the 13 patients treated by Diaz. 4 In the series by Kocer et al, only 2 procedural complications occurred (dissection leading to cerebral TIA with multiple emboli seen on MRI, and ophthalmic artery TIA with preserved patency), representing a 6% thromboembolic complication rate with 0% permanent morbidity and mortality. 10 However, delayed "fish mouthing" or foreshortening of the stent after deployment was noted in approximately 15% of patients, although none of these stent morphological complications had clinical sequelae.…”

“…10 This paper provides the largest series of patients treated with the FRED to date, with the only other patient series being the recently published series of 13 patients with 14 aneurysms by Diaz et al 4 Kocer's 33 patient series, although retrospective and unblinded, indicates excellent angiographic occlusion following treatment. Similar to other flow diversion technologies, angiographic occlusion improved with time such that 8 of 8 patients evaluated with angiographic imaging between 7 and 12 months from device deployment demonstrated complete angiographic aneurysm obliteration.…”

The Expanding Realm of Endovascular Neurosurgery: Flow Diversion for Cerebral Aneurysm Management

“…Second-generation devices vary in surface-area coverage and in the mechanism for ease of deployment. 41 Data suggest that a stent with an overall porosity of 50% to 70% (30-50% metallic surface-area coverage) significantly reduces the rate of inflow into an aneurysm. 43 The optimal device porosity and pore density that will spare jailed perforators and small branches while achieving near-perfect aneurysm occlusion remains the "Holy Grail" of flow-diversion devices and is a subject of intense interest for competing industry leaders and researchers alike.…”

“…Although flow diversion was originally conceived for the treatment of intracranial aneurysms, the use of flow diverters is expanding into visceral and peripheral aneurysms as operators are gaining experience and confidence. 40 Currently, this technology is in a transition period that is leading to second-generation devices, including the next iteration of the PED, the aforementioned FRED 41 and Surpass devices, both of which have been approved for use in other countries. 42 Clinical trials of both devices are currently underway in the United States.…”