Comparison of ped and fred flow diverters for posterior circulation aneurysms: a propensity score matched cohort study

Christoph J. Griessenauer, Alejandro Enriquez-Marulanda, Sissi Xiang, Tao Hong, Hongqi Zhang, Philipp Taussky, Ramesh Grandhi, Muhammad Waqas, Vincent M. Tutino, Adnan H. Siddiqui, Elad I. Levy, Christopher S. Ogilvy, Ajith J. Thomas, Christian Ulfert, Markus A. Möhlenbruch, Leonardo Renieri, Nicola Limbucci, Carmen Parra-Fariñas, Jan Karl Burkhardt, Peter KanLorenzo Rinaldo, Giuseppe Lanzino, Waleed Brinjikji, Julian Spears, Erasmia Müller-Thies-Broussalis, Monika Killer-Oberpfalzer, Civan Islak, Naci Kocer, Michael Sonnberger, Tobias Engelhorn, Mandeep Ghuman, Victor X.D. Yang, Arsalaan Salehani, Mark R. Harrigan, Ivan Radovanovic, Vitor M. Pereira, Timo Krings, Charles C. Matouk, Karen Chen, Mohammad Ali Aziz-Sultan, Mohammad Ghorbani, Clemens M. Schirmer, Oded Goren, Shamsher S. Dalal, Matthew J. Koch, Christopher J. Stapleton, Aman B. Patel, Thomas Finkenzeller, Markus Holtmannspötter, Jan Hendrik Buhk, Paul Michael Foreman, Marshall Cress, Robert Hirschl, Wolfgang Reith, Andreas Simgen, Hendrik Janssen, Thomas R. Marotta, Adam A. Dmytriw

Research output: Contribution to journalArticle


Background: Flow diversion is a common endovascular treatment for cerebral aneurysms, but studies comparing different types of flow diverters are scarce. Objective: To perform a propensity score matched cohort study comparing the Pipeline Embolization Device (PED) and Flow Redirection Intraluminal Device (FRED) for posterior circulation aneurysms. Methods: Consecutive aneurysms of the posterior circulation treated at 25 neurovascular centers with either PED or FRED were collected. Propensity score matching was used to control for age, duration of follow-up imaging, adjunctive coiling, and aneurysm location, size, and morphology; previously ruptured aneurysms were excluded. The two devices were compared for the following outcomes: procedural complications, aneurysm occlusion, and functional outcome. Results: A total of 375 aneurysms of the posterior circulation were treated in 369 patients. The PED was used in 285 (77.2%) and FRED in 84 (22.8%) procedures. Aneurysms treated with the PED were more commonly fusiform and larger than those treated with FRED. To account for these important differences, propensity score matching was performed resulting in 33 PED and FRED unruptured aneurysm pairs. No differences were found in occlusion status and neurologic thromboembolic or hemorrhagic complications between the two devices. The proportion of patients with favorable functional outcome was higher with FRED (100% vs 87.9%, p=0.04). Conclusion: Comparative analysis of PED and FRED for the treatment of unruptured posterior circulation aneurysms did not identify significant differences in aneurysm occlusion or neurologic complications. Variations in functional outcomes warrant additional investigations.

Original languageEnglish (US)
JournalJournal of neurointerventional surgery
StateAccepted/In press - 2020


  • Aneurysm
  • Embolic
  • Flow diverter
  • Intervention
  • Posterior fossa

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Griessenauer, C. J., Enriquez-Marulanda, A., Xiang, S., Hong, T., Zhang, H., Taussky, P., Grandhi, R., Waqas, M., Tutino, V. M., Siddiqui, A. H., Levy, E. I., Ogilvy, C. S., Thomas, A. J., Ulfert, C., Möhlenbruch, M. A., Renieri, L., Limbucci, N., Parra-Fariñas, C., Burkhardt, J. K., ... Dmytriw, A. A. (Accepted/In press). Comparison of ped and fred flow diverters for posterior circulation aneurysms: a propensity score matched cohort study. Journal of neurointerventional surgery.