Flow Diverters for Aneurysm Treatment: Scoping Review with ☸SAIMSARA

Abstract

Abstract

To synthesize the structured extraction evidence on “flow diverter” studies, emphasizing clinical effectiveness, safety, mechanistic rationale, procedural determinants, device evolution, imaging follow-up, antiplatelet strategy, and research directions relevant to FD use. The review uses 252 references and builds its evidence map from 1439 original studies with 161646 total participants/sample observations (topic-deduplicated ΣN). Across this evidence map, flow diversion emerges as a mature but selection-sensitive reconstructive therapy whose benefit is conditional on matching aneurysm anatomy, device mechanics, and periprocedural management. The most consistent signal supports durable occlusion in large, giant, wide-neck, and internal carotid aneurysms, with randomized data showing 75.34% versus 24.53% complete occlusion favoring Tubridge over stent-assisted coiling and Surpass reaching 90.2% occlusion at 5 years, while middle cerebral bifurcation, fetal-type posterior communicating, branch-incorporated, and acutely ruptured lesions remain higher-risk indications. Deployment quality, apposition, sizing, and antiplatelet strategy repeatedly emerged as modifiable determinants of outcome rather than fixed device properties. The dominant uncertainty is comparative: head-to-head randomized trials in anatomically defined subgroups, paired with harmonized occlusion and complication endpoints, are the priority next step to convert this largely retrospective signal into actionable guidance.