Impact of surface coating on postinterventional DWI lesions: A comparative analysis of coated and uncoated FRED and DERIVO flow-diverters in the treatment of intracranial aneurysms.

PurposeRecent advancements in flow-diverter (FD) technology have introduced various coating strategies to reduce platelet aggregation and thromboembolic complications in intracranial aneurysm treatment. This study compared postinterventional diffusion-weighted imaging (DWI) lesions, as markers of thromboembolic events, between coated and uncoated FDs.MethodsA retrospective analysis was conducted on patients treated for intracranial aneurysms between June 2018 and December 2024. The primary outcome was the occurrence of postinterventional DWI + lesions, with periprocedural factors analyzed for their association.ResultsA total of 91 patients with 104 aneurysms were treated with 43 uncoated (n = 30 FRED, n = 13 DERIVO) and 51 coated FDs (n = 36 FREDX, n = 15 DERIVO2Heal). DWI + lesions were observed in 39.5% of uncoated and 54.9% of coated FD cases (p = 0.1). After 1:1 propensity score matching, no significant difference was found (p = 0.131). Contrast stasis (p = 0.025) within aneurysm sac after FD deployment, FD proximal/distal ratio (p = 0.007), FD size (p = 0.047), and intervention duration (p = 0.036) were significantly associated with DWI + lesions. In multivariable analysis, contrast stasis (ORa = 3.7, 95% CI 1.1-11.9, p = 0.029), FD proximal/distal ratio (ORa = 27.8, 95% CI 1.8-426.8, p = 0.017), and older age (ORa = 1.06, 95% CI 1.00-1.11, p = 0.050) increased incidence of DWI + lesions.ConclusionIn this single-center observational study, coated FRED and DERIVO FDs did not reduce postinterventional DWI + lesions compared to their uncoated counterparts.