{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T10:01:30Z","timestamp":1785492090298,"version":"3.56.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Distal intracranial aneurysms are relatively rare in clinical practice and are characterized by distal location, smaller parent vessels, and fragile surrounding brain tissue, which are associated with a relatively higher risk of treatment-related complications such as ischemia and rebleeding. Traditional flow diverter stents have a thin tip, delivery wire can cause intraparenchymal hemorrhage or distal vessel perforation, particularly when attempting to navigate through complex, narrow, or fragile arteries. Therefore, the use of flow diverter devices in the treatment of distal intracranial aneurysms remains technically challenging. Flow diverter devices have been widely used for the treatment of wide-neck intracranial aneurysms; however, comparative data between the domestically developed Lattice device (Accu Medical, China) and the Pipeline Embolization Device remain limited. In this study, we compared the efficacy and safety of these two flow diverters in the treatment of unruptured distal intracranial aneurysms, based on scheduled postoperative imaging follow-up using computed tomography angiography (CTA) and digital subtraction angiography (DSA), focusing on aneurysm occlusion, complications, and branch vessel occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 47 patients with distal intracranial aneurysms treated with flow diverter devices between January 2020 and July 2025, who underwent implantation of either the Lattice or Pipeline stent. All patients underwent imaging follow-up at 6\u202fmonths postoperatively using either computed tomography angiography (CTA) or digital subtraction angiography (DSA). Inverse probability weighting (IPTW) was performed to balance baseline characteristics between the two groups. Baseline characteristics before and after IPTW are presented in Table 1. After adjusting for age, sex, hypertension, diabetes, preoperative mRS, aneurysm location, aneurysm morphology (saccular vs. fusiform), neck type (wide vs. narrow), maximum aneurysm diameter, neck size, dome-to-neck ratio, the inflow angle of the aneurysm (IFAA), branch vessel diameter, branch vessel origin, and mean parent vessel diameter, propensity scores were calculated for inverse probability of treatment weighting (IPTW). We applied 1\/PS as a weight for the Lattice group and 1\/(1\u202f\u2212\u202fPS) for the Pipeline group. Inverse probability weighting was applied, and logistic regression analysis was performed to identify factors potentially associated with aneurysm occlusion. Aneurysm healing was assessed using the OKM grading scale, with grades 0\u20132 defined as poor occlusion and grades 3\u20134 defined as favorable occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with the Pipeline group, no statistically significant differences were observed in aneurysm occlusion rates or branch vessel occlusion rates in the Lattice group at a median follow-up duration of 179\u202fdays (77.8% vs. 75.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.586). Among 18 patients treated with the Lattice device, 14 achieved favorable occlusion on follow-up imaging (14\/18, 77.8%), whereas 22 of 29 patients treated with the Pipeline device demonstrated favorable occlusion (22\/29, 75.9%). Branch vessel occlusion covered by the stent occurred in 3 patients in the Lattice group (3\/18, 16.7%), which was slightly higher than that in the Pipeline group (2\/29, 6.9%); however, this difference was not statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.317). Logistic regression analysis identified the IFAA as a potential factor associated with delayed or incomplete aneurysm healing. Specifically, for each 1-degree increase in this angle, the odds of aneurysm occlusion decreased by 3.5% (OR\u202f=\u202f0.965, 95% CI: 0.933\u20130.998,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.037). In addition, IPTW-adjusted univariate weighted logistic regression showed that larger aneurysm neck diameter (OR 0.685, 95% CI 0.505\u20130.929,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.016), presence of branch vessel origin from aneurysms (OR 0.065, 95% CI 0.011\u20130.364,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003) were also associated with unfavorable OKM outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>After IPTW adjustment, Lattice and Pipeline devices demonstrated comparable efficacy and safety in the treatment of distal cerebral aneurysms. Aneurysm geometric and anatomical factors, including the inflow angle (IFAA), aneurysm neck diameter and branch vessel origin, were independently associated with incomplete or delayed aneurysm occlusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1851112","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T04:24:01Z","timestamp":1783571041000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of lattice and pipeline flow diverters for the treatment of distal intracranial aneurysms: an inverse probability of treatment weighting analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Xinke","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aoming","family":"Jin","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Mechanical and Engineering, University of Science and Technology Beijing","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian-Jie","family":"Lyu","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"Beijing Key Laboratory of Drug and Device Research and Development for Cerebrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenqi","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology","place":["Tai Po Tsai, Hong Kong SAR, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qichen","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuanping","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieran","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinjian","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiqing","family":"Mu","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"S85","DOI":"10.1093\/neuros\/nyz334","article-title":"Expanding indications for flow diverters: distal aneurysms, bifurcation aneurysms, small aneurysms, previously coiled aneurysms and clipped aneurysms, and carotid cavernous fistulas","volume":"86","author":"Limbucci","year":"2020","journal-title":"Neurosurgery"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1148\/radiol.12120422","article-title":"Intracranial aneurysms: midterm outcome of pipeline embolization device--a prospective study in 143 patients with 178 aneurysms","volume":"265","author":"Yu","year":"2012","journal-title":"Radiology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"171","DOI":"10.25259\/SNI_223_2021","article-title":"Current treatment options and prognostic factors for ruptured distal anterior cerebral artery aneurysms","volume":"12","author":"Take","year":"2021","journal-title":"Surg Neurol Int"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1227\/01.NEU.0000043642.46308.D1","article-title":"Combined microsurgical and endovascular management of complex intracranial aneurysms","volume":"52","author":"Lawton","year":"2003","journal-title":"Neurosurgery"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1093\/neurosurgery\/46.1.226","article-title":"Planned direct dual-modality treatment of complex broad-necked intracranial aneurysms: four technical case reports","volume":"46","author":"Cockroft","year":"2000","journal-title":"Neurosurgery"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1227\/01.neu.0000333295.59738.de","article-title":"The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular era","volume":"62","author":"Sanai","year":"2008","journal-title":"Neurosurgery"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1729763","DOI":"10.3389\/fneur.2026.1729763","article-title":"Lattice flow diverter for the treatment of small and medium-sized anterior circulation aneurysms","volume":"17","author":"Ma","year":"2026","journal-title":"Front Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1612754","DOI":"10.3389\/fmed.2025.1612754","article-title":"Lattice innovative flow diverter with mechanical balloons: a new breakthrough and efficacy evaluation in the treatment of unruptured intracranial 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aneurysms","volume":"13","author":"Chen","year":"2023","journal-title":"Sci Rep"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1136\/neurintsurg-2020-016790","article-title":"Long-term safety and efficacy of distal aneurysm treatment with flow diversion in the M2 segment of the middle cerebral artery and beyond","volume":"13","author":"Cimflova","year":"2021","journal-title":"J Neurointerv Surg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1136\/neurintsurg-2020-015980","article-title":"Distal anterior cerebral artery aneurysms treated with flow diversion: experience of a large-volume center and systematic review of the literature","volume":"13","author":"Cagnazzo","year":"2021","journal-title":"J Neurointerv Surg."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1136\/jnis-2025-023362","article-title":"Flow diversion for distal cerebral aneurysms: a systematic review and 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aneurysm","volume":"63","author":"Lee","year":"2020","journal-title":"J Korean Neurosurg Soc"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1136\/neurintsurg-2017-013559","article-title":"Feasibility, complications, morbidity, and mortality results at 6 months for aneurysm treatment with the flow re-direction endoluminal device: report of SAFE study","volume":"10","author":"Pierot","year":"2018","journal-title":"J Neurointerv Surg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1097\/JCMA.0000000000000619","article-title":"Flow-diverter stent to manage intracranial aneurysms: a single center experience","volume":"85","author":"Feng","year":"2022","journal-title":"J Chin Med Assoc"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1093\/neuros\/nyy092","article-title":"The importance of wall apposition in flow diverters","volume":"84","author":"Aquarius","year":"2019","journal-title":"Neurosurgery"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3174\/ajnr.A7350","article-title":"Parent artery straightening after flow-diverter stenting improves the odds of aneurysm occlusion","volume":"43","author":"Janot","year":"2022","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1177\/1591019916641315","article-title":"Larger inflow angle and incomplete occlusion predict recanalization of unruptured paraclinoid aneurysms after endovascular treatment","volume":"22","author":"Ji","year":"2016","journal-title":"Interv Neuroradiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e716","DOI":"10.1016\/j.wneu.2023.10.014","article-title":"Inflow angle and height-width ratio are predictors of incomplete occlusion at one and two years after flow diverter treatment for small- and medium-sized internal carotid artery aneurysms","volume":"180","author":"Nariai","year":"2023","journal-title":"World Neurosurg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.1227\/neu.0000000000003788","article-title":"Comparison of lattice flow diverter and pipeline embolization device in unruptured intracranial aneurysms: a real-world, propensity score matching study","volume":"98","author":"Bao","year":"2026","journal-title":"Neurosurgery"}],"updated-by":[{"DOI":"10.3389\/fneur.2026.1941374","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000}}],"container-title":["Frontiers in 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