{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T16:12:38Z","timestamp":1788970358980,"version":"build-2803163510"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Treatment of ruptured aneurysms arising from small-caliber (< 2.5 mm) or distal vessels beyond the circle of Willis is considered challenging with all treatment modalities. Recently, the Flow Re-Direction Endoluminal Device Junior (FRED Jr) stent, designed for flow diversion in small arteries, was approved in the United States for the treatment of nonruptured aneurysms. Here, the authors report their experience using this device in the setting of subarachnoid hemorrhage (SAH).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Clinical and radiological records of patients sustaining SAH treated with a FRED Jr stent between June 2020 and October 2022 were reviewed. Treatment course, including antiplatelet therapy, external ventricular drain (EVD) management, and vasospasm, and clinical outcomes were analyzed. Angiographic results were assessed according to the O\u2019Kelly-Marotta (OKM) grading scale.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Nine patients at a median age of 62 (range 27\u201375) years were included. The median Hunt and Hess grade was II (IQR I) and the median modified Fisher grade was 4 (IQR 1). Aneurysm morphology types included saccular (6 patients), blister (1 patient), and dissecting (2 patients), and the aneurysms were located at the anterior communicating artery complex (n = 3) at the A2\/A3 (n = 3), M2\/M3 (n = 1), V4 (n = 1), and P2 (n = 1) arterial segments. All stents were deployed successfully with no intraprocedural complications. Postoperatively, no rebleeding events were encountered. Vasospasm therapy was initiated in 6 patients, and no symptomatic EVD-related hematomas were observed. Postoperative ischemic events were encountered in 2 patients. The median 3-month modified Rankin Scale score was 2 (IQR 1) for the 7 surviving patients, and 3-month radiographic follow-up revealed OKM grade D in 4 of 7 patients.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Flow diversion using the FRED Jr stent is feasible as a potential treatment strategy for acutely ruptured aneurysms arising from small-caliber vessels. The complication profile reported in this series is comparable to those of historical microsurgical cohorts, and effective protection was conferred by this treatment modality. Therefore, our small cohort provides a glimpse into a new tool for successfully achieving acute flow diversion for this subset of difficult-to-treat aneurysms.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2023.2.focus22645","type":"journal-article","created":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T07:20:50Z","timestamp":1682925650000},"page":"E6","source":"Crossref","is-referenced-by-count":15,"title":["FRED Jr stent for acute flow diversion in ruptured cerebral aneurysms arising from small-caliber vessels: a clinical case series"],"prefix":"10.3171","volume":"54","author":[{"given":"Omer","family":"Doron","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"McLellan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin E.","family":"Vranic","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Regenhardt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Stapleton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Neuroimaging","first-page":"81","article-title":"The role of endovascular treatment for ruptured distal anterior cerebral artery aneurysms: comparison with microsurgical clipping","volume":"25","author":"Park KY","year":"2015","unstructured":"Park KY, Kim BM, Lim YC, The role of endovascular treatment for ruptured distal anterior cerebral artery aneurysms: comparison with microsurgical clipping. J Neuroimaging. 2015;25(1):81\u201386.24299470"},{"issue":"1","key":"b2","series-title":"Interv Neuroradiol","first-page":"49","article-title":"Outcomes analysis of ruptured distal anterior cerebral artery aneurysms treated by endosaccular embolization and surgical clipping","volume":"17","author":"Suzuki S","year":"2011","unstructured":"Suzuki S, Kurata A, Yamada M, Outcomes analysis of ruptured distal anterior cerebral artery aneurysms treated by endosaccular embolization and surgical clipping. Interv Neuroradiol. 2011;17(1):49\u201357.21561558"},{"key":"b3","series-title":"Acta Neurochir Suppl (Wien)","first-page":"15","article-title":"Distal anterior cerebral artery aneurysms","volume":"107","author":"Lehecka M","year":"2010","unstructured":"Lehecka M, Dashti R, Lehto H, Kivisaari R, Niemel\u00e4 M, Hernesniemi J. Distal anterior cerebral artery aneurysms. Acta Neurochir Suppl (Wien). 2010;107:15-26."},{"issue":"1","key":"b4","series-title":"World Neurosurg","first-page":"76","article-title":"Surgical treatment of blister-like aneurysms","volume":"77","author":"Garrett M","year":"2012","unstructured":"Garrett M, Spetzler RF. Surgical treatment of blister-like aneurysms. World Neurosurg. 2012;77(1):76\u201377.22405389"},{"issue":"4","key":"b5","series-title":"J Neurosci Rural Pract","first-page":"711","article-title":"Contemporary management of distal anterior cerebral artery aneurysms: a dual-trained neurosurgeon\u2019s perspective","volume":"12","author":"Furtado SV","year":"2021","unstructured":"Furtado SV, Jayakumar D, Perikal PJ, Mohan D. Contemporary management of distal anterior cerebral artery aneurysms: a dual-trained neurosurgeon\u2019s perspective. J Neurosci Rural Pract. 2021;12(4):711\u2013717.34737505"},{"issue":"2","key":"b6","series-title":"Neurol Res","first-page":"119","article-title":"Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels","volume":"32","author":"Zhang J","year":"2010","unstructured":"Zhang J, Lv X, Jiang C, Li Y, Yang X, Wu Z. Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels. Neurol Res. 2010;32(2):119\u2013122.19825275"},{"issue":"11","key":"b7","series-title":"J Neurointerv Surg","first-page":"816","article-title":"Pipeline endovascular device for the treatment of intracranial aneurysms at the level of the circle of Willis and beyond: multicenter experience","volume":"7","author":"Mart\u00ednez-Gald\u00e1mez M","year":"2015","unstructured":"Mart\u00ednez-Gald\u00e1mez M, Romance A, Vega P, Pipeline endovascular device for the treatment of intracranial aneurysms at the level of the circle of Willis and beyond: multicenter experience. J Neurointerv Surg. 2015;7(11):816\u2013823.25200247"},{"key":"b8","series-title":"World Neurosurg","first-page":"e575","article-title":"The use of flow diversion in vessels \u22642.5 mm in diameter\u2014a single-center experience","volume":"118","author":"Bhogal P","year":"2018","unstructured":"Bhogal P, Chudyk J, Bleise C, The use of flow diversion in vessels \u22642.5 mm in diameter\u2014a single-center experience. 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J Neurointerv Surg. 2022;14(7):699\u2013703.34266906"},{"issue":"2","key":"b13","series-title":"Interv Neuroradiol","first-page":"133","article-title":"A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents","volume":"16","author":"O\u2019Kelly CJ","year":"2010","unstructured":"O\u2019Kelly CJ, Krings T, Fiorella D, Marotta TR. A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents. Interv Neuroradiol. 2010;16(2):133\u2013137.20642887"},{"issue":"3","key":"b14","series-title":"J Neurointerv Surg","first-page":"202","article-title":"Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents","volume":"7","author":"Aydin K","year":"2015","unstructured":"Aydin K, Arat A, Sencer S, Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg. 2015;7(3):202\u2013209.24491271"},{"issue":"9","key":"b15","series-title":"J Neurointerv Surg","first-page":"851","article-title":"Stent and flow diverter assisted treatment of acutely ruptured brain aneurysms","volume":"10","author":"Cohen JE","year":"2018","unstructured":"Cohen JE, Gomori JM, Leker RR, Spektor S, Abu El Hassan H, Itshayek E. Stent and flow diverter assisted treatment of acutely ruptured brain aneurysms. J Neurointerv Surg. 2018;10(9):851\u2013858.29778996"},{"key":"b16","series-title":"Front Neurol","first-page":"671915","article-title":"Endovascular treatment of intracranial aneurysms in small peripheral vessel segments\u2014efficacy and intermediate follow-up results of flow diversion with the Silk Vista Baby low-profile flow diverter","volume":"12","author":"Sch\u00fcngel MS","year":"2021","unstructured":"Sch\u00fcngel MS, Qu\u00e4schling U, Weber E, Endovascular treatment of intracranial aneurysms in small peripheral vessel segments\u2014efficacy and intermediate follow-up results of flow diversion with the Silk Vista Baby low-profile flow diverter. Front Neurol. 2021;12:671915.34122317"},{"issue":"12","key":"b17","series-title":"J Neurointerv Surg","first-page":"1227","article-title":"Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent","volume":"11","author":"Schob S","year":"2019","unstructured":"Schob S, Hoffmann KT, Richter C, Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent. J Neurointerv Surg. 2019;11(12):1227\u20131234.31088939"},{"issue":"9","key":"b18","series-title":"AJNR Am J Neuroradiol","first-page":"1669","article-title":"Acutely ruptured intracranial aneurysms treated with flow-diverter stents: a systematic review and meta-analysis","volume":"39","author":"Cagnazzo F","year":"2018","unstructured":"Cagnazzo F, di Carlo DT, Cappucci M, Lefevre PH, Costalat V, Perrini P. Acutely ruptured intracranial aneurysms treated with flow-diverter stents: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2018;39(9):1669\u20131675.30049721"},{"issue":"4","key":"b19","series-title":"J Neurosurg","first-page":"1021","article-title":"Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling","volume":"114","author":"Kung DK","year":"2011","unstructured":"Kung DK, Policeni BA, Capuano AW, Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg. 2011;114(4):1021\u20131027.20950080"},{"issue":"3","key":"b20","series-title":"Br J Neurosurg","first-page":"270","article-title":"Increased risk of ventriculostomy-associated hemorrhage in patients treated with antiplatelet agents for stent-assisted coiling of ruptured intracranial aneurysms","volume":"35","author":"Qin G","year":"2021","unstructured":"Qin G, Pang G, Zhong S, Chen H, Tang X, Lan S. Increased risk of ventriculostomy-associated hemorrhage in patients treated with antiplatelet agents for stent-assisted coiling of ruptured intracranial aneurysms. Br J Neurosurg. 2021;35(3):270\u2013274.32643426"},{"issue":"1","key":"b1","series-title":"J Neuroimaging","first-page":"81","article-title":"The role of endovascular treatment for ruptured distal anterior cerebral artery aneurysms: comparison with microsurgical clipping","volume":"25","author":"Park KY","year":"2015","unstructured":"Park KY, Kim BM, Lim YC, The role of endovascular treatment for ruptured distal anterior cerebral artery aneurysms: comparison with microsurgical clipping. J Neuroimaging. 2015;25(1):81\u201386.24299470"},{"issue":"1","key":"b2","series-title":"Interv Neuroradiol","first-page":"49","article-title":"Outcomes analysis of ruptured distal anterior cerebral artery aneurysms treated by endosaccular embolization and surgical clipping","volume":"17","author":"Suzuki S","year":"2011","unstructured":"Suzuki S, Kurata A, Yamada M, Outcomes analysis of ruptured distal anterior cerebral artery aneurysms treated by endosaccular embolization and surgical clipping. Interv Neuroradiol. 2011;17(1):49\u201357.21561558"},{"key":"b3","series-title":"Acta Neurochir Suppl (Wien)","first-page":"15","article-title":"Distal anterior cerebral artery aneurysms","volume":"107","author":"Lehecka M","year":"2010","unstructured":"Lehecka M, Dashti R, Lehto H, Kivisaari R, Niemel\u00e4 M, Hernesniemi J. Distal anterior cerebral artery aneurysms. Acta Neurochir Suppl (Wien). 2010;107:15-26."},{"issue":"1","key":"b4","series-title":"World Neurosurg","first-page":"76","article-title":"Surgical treatment of blister-like aneurysms","volume":"77","author":"Garrett M","year":"2012","unstructured":"Garrett M, Spetzler RF. Surgical treatment of blister-like aneurysms. World Neurosurg. 2012;77(1):76\u201377.22405389"},{"issue":"4","key":"b5","series-title":"J Neurosci Rural Pract","first-page":"711","article-title":"Contemporary management of distal anterior cerebral artery aneurysms: a dual-trained neurosurgeon\u2019s perspective","volume":"12","author":"Furtado SV","year":"2021","unstructured":"Furtado SV, Jayakumar D, Perikal PJ, Mohan D. Contemporary management of distal anterior cerebral artery aneurysms: a dual-trained neurosurgeon\u2019s perspective. J Neurosci Rural Pract. 2021;12(4):711\u2013717.34737505"},{"issue":"2","key":"b6","series-title":"Neurol Res","first-page":"119","article-title":"Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels","volume":"32","author":"Zhang J","year":"2010","unstructured":"Zhang J, Lv X, Jiang C, Li Y, Yang X, Wu Z. Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels. Neurol Res. 2010;32(2):119\u2013122.19825275"},{"issue":"11","key":"b7","series-title":"J Neurointerv Surg","first-page":"816","article-title":"Pipeline endovascular device for the treatment of intracranial aneurysms at the level of the circle of Willis and beyond: multicenter experience","volume":"7","author":"Mart\u00ednez-Gald\u00e1mez M","year":"2015","unstructured":"Mart\u00ednez-Gald\u00e1mez M, Romance A, Vega P, Pipeline endovascular device for the treatment of intracranial aneurysms at the level of the circle of Willis and beyond: multicenter experience. J Neurointerv Surg. 2015;7(11):816\u2013823.25200247"},{"key":"b8","series-title":"World Neurosurg","first-page":"e575","article-title":"The use of flow diversion in vessels \u22642.5 mm in diameter\u2014a single-center experience","volume":"118","author":"Bhogal P","year":"2018","unstructured":"Bhogal P, Chudyk J, Bleise C, The use of flow diversion in vessels \u22642.5 mm in diameter\u2014a single-center experience. World Neurosurg. 2018;118:e575\u2013e583.29990606"},{"issue":"6","key":"b9","series-title":"J Neurosurg Sci","first-page":"702","article-title":"Flow diversion for small caliber vessel aneurysms: efficacy, safety, and functional outcome","volume":"63","author":"Sweid A","year":"2019","unstructured":"Sweid A, Starke RM, Herial N, Flow diversion for small caliber vessel aneurysms: efficacy, safety, and functional outcome. J Neurosurg Sci. 2019;63(6):702\u2013713.31111723"},{"issue":"10","key":"b10","series-title":"AJNR Am J Neuroradiol","first-page":"1959","article-title":"Multicenter experience with FRED Jr flow re-direction endoluminal device for intracranial aneurysms in small arteries","volume":"38","author":"M\u00f6hlenbruch MA","year":"2017","unstructured":"M\u00f6hlenbruch MA, Kizilkilic O, Killer-Oberpfalzer M, Multicenter experience with FRED Jr flow re-direction endoluminal device for intracranial aneurysms in small arteries. AJNR Am J Neuroradiol. 2017;38(10):1959\u20131965."},{"issue":"3","key":"b11","series-title":"Jpn J Radiol","first-page":"322","article-title":"Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience","volume":"41","author":"Sayin B","year":"2023","unstructured":"Sayin B, \u015eenol YC, Daglioglu E, \u00d6zbak\u0131r MO, Orhan G, Akmangit \u0130. Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience. Jpn J Radiol. 2023;41(3):322\u2013334."},{"issue":"7","key":"b12","series-title":"J Neurointerv Surg","first-page":"699","article-title":"Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms","volume":"14","author":"Alpay K","year":"2022","unstructured":"Alpay K, Hinkka T, Lindgren AE, Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms. J Neurointerv Surg. 2022;14(7):699\u2013703.34266906"},{"issue":"2","key":"b13","series-title":"Interv Neuroradiol","first-page":"133","article-title":"A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents","volume":"16","author":"O\u2019Kelly CJ","year":"2010","unstructured":"O\u2019Kelly CJ, Krings T, Fiorella D, Marotta TR. A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents. Interv Neuroradiol. 2010;16(2):133\u2013137.20642887"},{"issue":"3","key":"b14","series-title":"J Neurointerv Surg","first-page":"202","article-title":"Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents","volume":"7","author":"Aydin K","year":"2015","unstructured":"Aydin K, Arat A, Sencer S, Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg. 2015;7(3):202\u2013209.24491271"},{"issue":"9","key":"b15","series-title":"J Neurointerv Surg","first-page":"851","article-title":"Stent and flow diverter assisted treatment of acutely ruptured brain aneurysms","volume":"10","author":"Cohen JE","year":"2018","unstructured":"Cohen JE, Gomori JM, Leker RR, Spektor S, Abu El Hassan H, Itshayek E. Stent and flow diverter assisted treatment of acutely ruptured brain aneurysms. J Neurointerv Surg. 2018;10(9):851\u2013858.29778996"},{"key":"b16","series-title":"Front Neurol","first-page":"671915","article-title":"Endovascular treatment of intracranial aneurysms in small peripheral vessel segments\u2014efficacy and intermediate follow-up results of flow diversion with the Silk Vista Baby low-profile flow diverter","volume":"12","author":"Sch\u00fcngel MS","year":"2021","unstructured":"Sch\u00fcngel MS, Qu\u00e4schling U, Weber E, Endovascular treatment of intracranial aneurysms in small peripheral vessel segments\u2014efficacy and intermediate follow-up results of flow diversion with the Silk Vista Baby low-profile flow diverter. Front Neurol. 2021;12:671915.34122317"},{"issue":"12","key":"b17","series-title":"J Neurointerv Surg","first-page":"1227","article-title":"Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent","volume":"11","author":"Schob S","year":"2019","unstructured":"Schob S, Hoffmann KT, Richter C, Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent. J Neurointerv Surg. 2019;11(12):1227\u20131234.31088939"},{"issue":"9","key":"b18","series-title":"AJNR Am J Neuroradiol","first-page":"1669","article-title":"Acutely ruptured intracranial aneurysms treated with flow-diverter stents: a systematic review and meta-analysis","volume":"39","author":"Cagnazzo F","year":"2018","unstructured":"Cagnazzo F, di Carlo DT, Cappucci M, Lefevre PH, Costalat V, Perrini P. Acutely ruptured intracranial aneurysms treated with flow-diverter stents: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2018;39(9):1669\u20131675.30049721"},{"issue":"4","key":"b19","series-title":"J Neurosurg","first-page":"1021","article-title":"Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling","volume":"114","author":"Kung DK","year":"2011","unstructured":"Kung DK, Policeni BA, Capuano AW, Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg. 2011;114(4):1021\u20131027.20950080"},{"issue":"3","key":"b20","series-title":"Br J Neurosurg","first-page":"270","article-title":"Increased risk of ventriculostomy-associated hemorrhage in patients treated with antiplatelet agents for stent-assisted coiling of ruptured intracranial aneurysms","volume":"35","author":"Qin G","year":"2021","unstructured":"Qin G, Pang G, Zhong S, Chen H, Tang X, Lan S. Increased risk of ventriculostomy-associated hemorrhage in patients treated with antiplatelet agents for stent-assisted coiling of ruptured intracranial aneurysms. 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