The FRED-X Flow Diverter—An Australian Experience

Abstract

Background

The FRED X flow diverter features antithrombotic surface treatment to reduce thrombogenicity. This study evaluated the safety and efficacy of FRED X in treating intracranial aneurysms in the Australian setting.

Methods

Clinical, procedural and imaging data were retrospectively reviewed for a consecutive series of patients at a single Australian neurovascular centre. Follow-up imaging was performed with a combination of MRA and IV-DSA imaging.

Results

A total of 39 consecutive patients (21% presenting with acute rupture) with 52 aneurysms treated with 40 FRED X devices between June 2021 and September 2024 were included in this study. Aneurysms were predominantly saccular (88%) and located in the ICA (82%), with a median size of 5.1 mm (IQR 2.4–8). Satisfactory wall apposition was achieved in 98% of cases. Additional coiling was performed in 20%, and balloon angioplasty in 5%. At a median follow-up of 28 weeks, complete aneurysm occlusion was achieved in 74% of cases, with adequate occlusion (> 90%) in 86%. Minor adverse events occurred in 10% and major adverse events in 5%. Overall mortality was 5%, exclusively in acute subarachnoid haemorrhage cases.

Conclusion

The FRED X demonstrates favourable safety and efficacy profiles, with high technical success rates and satisfactory occlusion outcomes in an Australian setting. Thrombotic complications were rare, possibly reflecting the benefits of the antithrombotic coating, though larger studies with longer-term follow-up are needed for confirmation.