Flex vs. Vantage Pipeline™ Flow Diverters: Technical analysis in treating complex fusiform basilar artery aneurysm

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Abstract
We present a case of an adult patient with a large symptomatic fusiform basilar artery aneurysm. This video demonstrates the ease of deploying the new Pipeline™ Vantage Flow Diverter compared to the Flex model in the same vessel. The Flex and Vantage have different deployment techniques—as using the Flex maneuvering technique on the Vantage may damage the braid. The Vantage stent does not require resheathing, dragging, or system loading. The video shows the operator's hands making multiple adjustments to deploy the Flex, while they deploy two Vantage stents and a LOBO ® device occluder before fully deploying the Flex. The Vantage appears to offer a simpler, more streamlined deployment process of mostly unsheathing compared to the Flex flow diverter. Also, the Vantage design might offer a higher aneurysmal occlusion rate with a shorter course of anti-platelet regimen. 1 Of note, the Pipeline™ Shield may be a more appropriate option in some cases.