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Objective: There have been few reports of the outcomes of flow re-direction endoluminal device (FRED) treatment for unruptured cerebral aneurysms, and patient factors associated with effective aneurysm obliteration have yet to be determined. Flow diverters also have problems with delayed rupture. The objective of this study was to investigate associations between the cases of early obliteration of aneurysm after FRED treatment and a range of factors. Method: A retrospective analysis of 75 aneurysms in 72 patients whose response to treatment was evaluated by cerebral angiography 6 months after FRED treatment was conducted. The aneurysm obliteration rate was classified according to the O'Kelly-Marotta grading scale (OKM grade). The patients were classified into those assessed as OKM Grade A or Grade B with poor aneurysm obliteration (poor obliteration), and those assessed as Grade C or Grade D with good aneurysm obliteration (good obliteration). The parameters evaluated were age, sex, medical history, immediate postoperative eclipse sign, P2Y12 reaction units (PRU), aspirin reaction units (ARU), operating time, maximum aneurysm diameter measured on cerebral angiography, and aneurysm location. Results: At 6 months post-treatment, 19 aneurysms (25.3%) were OKM Grade A, 15 (20%) were Grade B, 10 (13.3%) were Grade C, and 31 (41.3%) were Grade D. Age ≥67.5 years was significantly associated with a poor obliteration [odds ratio (OR): 0.1; 95% confidence interval (95%CI): 0.2-0.4; p=0.002] and intracranial side wall aneurysm [OR: 21.7; 95%CI: 1.6–284.5; p=0.01]. Conclusions: The results of this study demonstrated that age was associated with aneurysm obliteration after FRED treatment. This finding may be useful for further studies investigating factors predictive of the aneurysm obliteration rate and the residual aneurysm rate after FRED treatment.

The Flow Re-direction Endoluminal Device (FRED) is widely used to treat large intracranial unruptured cerebral aneurysms; however, some cases of deployment failure have been observed. Most of these cases occur in internal carotid artery aneurysms around the siphon. We report a method that we developed to predict the success of FRED deployment by using a preoperative angiography in simple lateral view.