Lattice versus Pipeline and Tubridge Flow Diverters for Unruptured Internal Carotid Artery Aneurysms: A Retrospective Cohort Study.

Abstract

The development of new-generation flow diverters (FDs), such as the Lattice FD, seeks to address the limitations of conventional devices in the treatment of anatomically complex unruptured internal carotid artery aneurysms. This study compares the procedural and angiographic outcomes of the novel Lattice FD with established devices (Pipeline and Tubridge). A retrospective cohort study was conducted at Qilu Hospital (2022-2024), including patients with unruptured internal carotid artery aneurysms treated with either Lattice or control FDs (Pipeline/Tubridge). The primary endpoints were stent deployment time, microguidewire manipulation frequency, 6-month complete occlusion (O'Kelly-Marotta grade D), and in-stent stenosis (≥50%). A total of 69 patients (Lattice, n = 36; control, n = 33) were included. The Lattice FD demonstrated significantly shorter median deployment time (P < 0.001) and lower microguidewire manipulation frequency (relative risk = 0.18, P = 0.007). At 6 months, the Lattice FD showed a higher complete occlusion rate in ophthalmic-segment aneurysms (P = 0.038). No in-stent stenosis was observed in the Lattice group compared to 12% in the controls (P = 0.043). In multivariable analysis, smaller aneurysm diameter was independently associated with higher occlusion rates (adjusted odds ratio 0.85 per mm increase, 95% confidence interval 0.72-0.99, P = 0.042). The Lattice FD was associated with enhanced procedural efficiency. While the overall 6-month occlusion rate was not significantly different, a higher rate was observed in ophthalmic-segment aneurysms, and the incidence of in-stent stenosis was lower. These findings suggest Lattice may be a viable alternative for select anatomical variants, though its noninferiority or superiority requires confirmation in larger studies.