X-Factor: Antithrombotic Coating Reduces Procedural Thromboembolic Events in Flow Redirection Endoluminal Device...

The Flow Redirection Endoluminal Device (FRED) is a dual-layer flow diverting stent with a dense inner mesh and outer braided support providing superior deployment control. Covalently bonded Poly(2-methoxyethyl acrylate) X coating was introduced to decrease metal-induced thrombogenicity in the newer FRED X variant. The objective of the current study is to evaluate procedural thromboembolic events associated with both variants.

A single-center retrospective analysis was undertaken comparing angiographically detected intraprocedural thromboembolic events, postprocedural magnetic resonance diffusion weighted imaging lesions (MR-DWI+), as well as a composite combined endpoint. Periprocedural (<24 hours) clinical events, demographics, aneurysm characteristics and platelet aggregation (using P2Y12 reactivity unit, PRU) were analyzed.

Treatment was performed with 19 FRED procedures in 18 patients with 19 aneurysms, and with 37 FRED X procedures in 35 patients harboring 40 aneurysms. Both groups achieved therapeutic preprocedural platelet inhibition by PRU testing. Intraprocedural thromboembolic events including intraluminal filling defects and side-branch slowing or loss occurred in 7/19 (36.8%) FRED and 0/37 FRED X procedures (P = 0.0002), with all being successfully recanalized using intra-arterial platelet inhibitors, without symptomatic ischemic or hemorrhagic events. The composite endpoint was reached in 11/19 (57.9%) FRED and 5/37 (13.5%) FRED X cases (P = 0.001), with multivariable analysis identifying device type (P = 0.015) among age, gender, and PRU.

The surface modification of the FRED X device may be associated with improved thrombogenic risk profile in our cohort, with elimination of intraprocedural thrombus formation and reduction of composite thromboembolic events.