| Summary: | Introduction The treatment paradigm for very large and giant aneurysms recently changed to flow diversion, in light of the results of the Pipeline for Uncoilable or Failed Aneurysms trial. However, the effects of flow diversion was definitely unknown. We explored this topic and identified predictors of such effects. Methods We retrospectively reviewed 51 patients with unruptured aneurysms admitted to our institution for flow diversion between February 2014 and August 2019. Patients were categorized into an effect group (no filling or remnant entry) and a no‐effect group (subtotal or total filling). We evaluated aneurysm size and shape, incorporation vessel, parent artery stenosis and curvature, stagnation of contrast medium within the aneurysm, use or not of balloon angioplasty, and intra‐aneurysm thrombus, as potential predictors of the effects of flow diversion. Results The effect group comprised 34 patients (66.7%, 34/51; no filling [35.3%, 18/51] and remnant entry [31.4% 16/51]). The no‐effect group comprised 17 patients (33.3%, 17/51; subtotal filling [29.4%, 15/51] and total filling [3.9% 2/51]). The presence of an incorporation vessel (odds ratio 0.13, p = 0.021) and balloon angioplasty (odds ratio 0.05, p = 0.004) were independent risk factors for poor flow diversion (no‐effect group) in multivariate logistic regression analyses. Conclusions Flow diversion is effective for very large and giant aneurysms but the outcomes require further improvement. The results of this study show that an incorporated vessel and excessive balloon angioplasty might compromise flow diversion. Considering this finding can help improve the outcomes of flow diversion.
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