Flow Diversion at Maturity: Further, Safer, Smarter

Two decades of evidence have established flow diversion as an effective treatment for intracranial aneurysms. As the field enters its third decade, the central question is no longer whether it works, but how to deliver reliable arterial reconstruction consistently across anatomies, operators, and clinical settings. This editorial argues that flow diversion has reached biological maturity but not yet clinical maturity. Distal and small-vessel applications are now feasible with acceptable safety, shifting the priority from broader indications toward greater precision. Surface-modified devices and evidence-based antiplatelet strategies-exemplified by the randomized COATING trial-are reducing thrombogenicity and enabling simplified regimens, while standardized frameworks (such as the F2B2 classification) help distinguish benign braid adaptation from true device instability. Realizing the technology's potential will depend on three priorities: standardized imaging assessment, predictive patient selection, and validated biological endpoints, alongside reproducible deployment technique and attention to economic sustainability and global access. In our view, the next decade should deliver not simply more flow diversion, but better flow diversion-more predictable, more accessible, and more durable.