Safety and Efficacy of Flow Diverter Stents for Intracranial Aneurysms in a Lower-Middle-Income Country: A Single-Center Experience

Purpose: Flow diverter (FD) stents are increasingly used for the treatment of intracranial aneurysms, with strong evidence supporting their use in unruptured aneurysms. However, real-world outcomes that include both ruptured and unruptured aneurysms are less well characterized. This study evaluated the safety, angiographic efficacy, and clinical outcomes of FD placement in a consecutive series at our center.

Materials and Methods: We retrospectively reviewed 60 patients who underwent FD stent placement between March 11, 2022 and August 15, 2025. Patient demographics, comorbidities, aneurysm characteristics, procedural details, and follow-up data were collected. Angiographic outcomes were assessed at 1, 6, and 12 months and categorized as complete or near-complete occlusion. Clinical outcomes were measured using the modified Rankin Scale (mRS). Subgroup comparisons were performed between ruptured and unruptured aneurysms as well as internal carotid versus vertebral artery aneurysms.

Results: The mean patient age was 42.9 ± 12.7 years, and 70% were female. Hypertension was present in 70% of patients, and 5% were smokers. At the time of treatment, 65% of aneurysms were unruptured, 25% were acutely ruptured, and 10% were previously ruptured. Most aneurysms were located in the internal carotid artery (90%), with the remainder in the vertebral artery (10%). Morphologically, 60% were saccular, 15% fusiform, 5% blister, and 20% other. At 1-month follow-up, all aneurysms demonstrated near-complete occlusion. At 6 months, 50% had achieved complete occlusion and 40% remained near-complete, while at 12 months, 65% were completely occluded and 25% near-complete. Ruptured aneurysms were significantly less likely to achieve complete occlusion at 12 months compared with unruptured aneurysms (p = 0.04). Clinically, 35% of patients had a favorable outcome (mRS ≤ 2) at discharge, which improved to 100% at last follow-up. No periprocedural ischemic or hemorrhagic complications occurred, and there were no in-hospital deaths, delayed complications, or retreatments.

Conclusion: Flow diverter stent placement was safe and effective in this series, with excellent angiographic progression and universal favorable clinical recovery at follow-up. Outcomes were superior in unruptured aneurysms, underscoring the need for further study of FD use in the ruptured setting.