{
  "abstract": "Introduction Flow diverters (FDs) have significantly advanced the treatment of intracranial aneurysms, particularly those that are large, wide-necked, or surgically inaccessible. However, the high metallic surface of traditional FDs poses a substantial thrombogenic risk, necessitating prolonged dual antiplatelet therapy (DAPT). Recent developments in FD surface modifications aim to mitigate thrombogenicity while promoting endothelialization, with the potential to enable safe treatment under single antiplatelet therapy (SAPT).Aim of Study This review aim to consolidate the molecular mechanisms, preclinical findings and clinical data of currently available coated flow diverters.Method Systematic review was performed using PubMed, Embase, Medline, Google Scholar) with search terms of (phosphorylcholine, PMEA, hydrophilic-polymer-coating, fibrin-heparin) and (Pipeline Shield, FRED X, p48/p64-HPC, Derivo 2heal).Results Phosphorylcholine-coated Pipeline Shield demonstrated good in-vitro hemocompatibility and animal-model endothelialization, though clinical outcomes under SAPT remain mixed. PMEA-coated FRED X showed promising safety and occlusion rates under DAPT with lower thromboembolic complications than uncoated FRED. HPC-coated p48/p64 devices showed favorable outcomes under P2Y12-inhibitor SAPT with some technical deployment challenges. The fibrin-heparin coated Derivo 2heal showed encouraging early safety data, though current evidence is limited to retrospective studies. Across devices, long-term healing data and prospective randomized SAPT trials are still emerging.Conclusion Surface-modified FDs demonstrate promising safety profiles and may enable expanded indications, including treatment under SAPT. However, clinical benefits over uncoated FDs are subtle, and current evidence does not definitively support one technology over another. Future randomized trials and in vivo imaging studies are needed to optimize antiplatelet strategies and validate endothelial healing advantages among surface coatings.Conflict of Interest No",
  "authors": [
    {
      "affiliations": [
        "National University Hospital, Singapore, Singapore"
      ],
      "name": "Si Zhao Tang"
    },
    {
      "affiliations": [
        "National University Hospital, Singapore, Singapore"
      ],
      "name": "Anil Gopinathan"
    }
  ],
  "title": "A346 A systematic review of biomimetic surface modifications in flow diverters for intracranial aneurysms: implications and clinical evidence",
  "uid": "dc6cdfd8-19a3-527e-87ea-1a3ce3cd30d3"
}