Background In recent years, newer flow diverters have been developed with surface modification and varying wire densities. Our study evaluated outcomes among three newer generation flow diverter devices, FRED-X, PED Shield and Surpass Evolve.

Methods This was a retrospective study of patients from five participating institutions across the United States. Patients who underwent flow diversion of intracranial aneurysms using the FRED-X, PED Shield or Surpass Evolve between February 2022 and September 2024 were included. Outcomes of interest were technical success, angiographic occlusion and in-stent stenosis (ISS).

Results Among 447 patients with 452 aneurysms, adjunct device use was highest with Surpass Evolve (36.4%) versus PED Shield (15.7%) and FRED-X (6.4%) (p < .001). Good wall apposition after angioplasty/stenting was most frequent with Surpass Evolve (32.3%) versus PED Shield (13.7%) and FRED-X (4.5%) (p < .001). At six months, complete occlusion was achieved in 69.3% (PED Shield), 63.6% (FRED-X), and 58% (Surpass Evolve) (p = .254). ISS rates were comparable at six months (p = .826). At 12 months, complete occlusion was observed in 78.9% of PED Shield, 68.4% of FRED-X, and 64.5% of Surpass Evolve aneurysms. Most ISS cases at 12 months were mild. Kaplan-Meier analysis showed no significant difference in occlusion rates (p = .914).

Conclusions Flow diversion using FRED-X, PED Shield and Surpass Evolve resulted in comparable rates of angiographic occlusion and ISS. However, adjunctive devices were more commonly needed with Surpass Evolve.