Journal of Advanced Clinical Neurology Research

Abstract

Surface modification of flow diverters—including Pipeline Embolization Devices (PEDs)—represents a key advance in neuroendovascular technology. By imparting antithrombotic or hemocompatible properties to inert metals, these modifications may reduce the risk of perioperative thromboembolic events and potentially shorten the duration of dual antiplatelet therapy (DAPT). Indeed, studies have demonstrated that specialized coatings and surface treatments can markedly decrease platelet activation. More recent developments have focused on optimizing hydrophilic properties, delivery force, and re-sheathability, thereby increasing neointimal coverage and improving the safety profile of PEDs. Long-term data have shown that PEDs can achieve high aneurysm occlusion rates, approaching 95% at 5-year follow-up for certain cohorts, which is comparable to open surgical clipping. Advances in basic science, translational research, and clinical applications consistently indicate that surface modifications enhance device performance and patient outcomes. This narrative review discusses the evolution of surface-modified PEDs, including their mechanisms, clinical advantages, potential risks, and future directions in neurointerventional practice.