Braided stents and their impact in intracranial aneurysm treatment for distal locations: from flow diverters to low profile stents

Intracranial aneurysms in distal locations are sometimes difficult to treat due to their branching locations and the presence of blister-like or very wide-necked aneurysms. Braided intracranial stents, including flow diverters (FDs) and low-profile braided intracranial stents (LPBSs) may provide additional advantages, due to their flow-diverting properties.The use of FDs in off-label, distal intracranial locations has been increasing with promising outcomes and has given rise to the LPBS, which has less flow-diverting properties, allowing for easier use in distal branching sites through 0.017' microcatheters. These devices have shifted the interest from the aneurysm's sac filling to the regional remodeling through the effect of flow diversion. The purpose of this article is to discuss their functionality, safety, performance, and perspectives through a critical review of important publications of the last 11.5 years (January 2007 to July 2018) on the use of these devices at and beyond the circle of Willis.FDs modify the regional anatomy thus careful pre-procedural consideration of the regional hemodynamic equilibrium is mandatory, as well as effective antiplatelet regimen. LPBSs provide moderate flow-diversion effect, which may be an advantage, especially for very distal and small aneurysms.