Defining biomaterial-driven design principles for bioabsorbable flow diverters: current state and perspectives

Bioactive Materials, vol. 67, pp. 1–21

Abstract

Flow diverters (FDs) have revolutionized intracranial aneurysm management, but current permanent metallic devices remain constrained by their bulk and surface properties, which induce chronic inflammation, thrombotic risk, and impaired vessel-wall integration. In this review we address these material-driven design challenges, examining how bioactive bioabsorbable biomaterials can overcome current limitations by balancing scaffold resorption with aneurysm occlusion. Moving beyond the clinical focus of existing literature, we establish a rational design roadmap bridging the gap between bulk material properties and FD architecture. We analyze how synchronized degradation kinetics and neointimal encapsulation govern device functionality, identifying this biological isolation as a necessary safety requirement to ensure resorption occurs only after the scaffold is shielded from the active flow. We analyze the mechanical-biological trade-offs of current platforms, whereby bioabsorbable polymers offer superior flexibility but limited radial support, whereas bioabsorbable metals provide higher mechanical integrity but require precision control over degradation. Hybrid strategies, combining transient and permanent components, emerge as effective solutions to balance mechanical reliability with controlled resorption. Across material classes, sustained flow diversion and vascular healing are primarily dictated by the interplay of scaffold architecture, material composition, and time-dependent surface evolution. Our analysis highlights that converging bulk material selection with advanced interfacial engineering enables the rational design of bioabsorbable FDs that maintain temporary mechanical integrity, while ensuring predictable aneurysm occlusion. These design principles establish a scientific framework for next-generation bioactive neurovascular implants, emphasizing a materials-driven approach to optimize safety and translational potential.

Authors 9

1. Amr F. Mohamed

   Otto-von-Guericke-Universität Magdeburg

   Affiliation as printed

   Department of Medical Engineering, Otto-von-Guericke University of Magdeburg, Magdeburg, 39106, Germany

   Embocraft GmbH, Triwo Technopark Aachen, Philipsstraße 8, Aachen, 52068, Germany

   Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, 39104, Germany

2. Benedetta Isella
   Affiliation as printed

   Fibrothelium GmbH, Triwo Technopark Aachen, Philipsstraße 8, Aachen, 52068, Germany

3. Daniel Behme

   University Hospital Magdeburg · Otto-von-Guericke-Universität Magdeburg

   Affiliation as printed

   Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, 39104, Germany

   University Clinic for Neuroradiology, Medical Faculty and University Hospital, Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany

4. Alexander Loewen Aachen Department of Biohybrid and Medical Textiles (BioTex) AME-Institute of Applied Medical Engineering

   RWTH Aachen University

   Affiliation as printed

   Department of Biohybrid & Medical Textiles (BioTex), AME - Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, 52074, Germany

5. Mark Vekemans
   Affiliation as printed

   Embocraft GmbH, Triwo Technopark Aachen, Philipsstraße 8, Aachen, 52068, Germany

6. Roland Schwab

   University Hospital Magdeburg · Otto-von-Guericke-Universität Magdeburg

   Affiliation as printed

   Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, 39104, Germany

   University Clinic for Neuroradiology, Medical Faculty and University Hospital, Otto-von-Guericke-University Magdeburg, Magdeburg, 39120, Germany

7. Tara C. Schmitz
   Affiliation as printed

   Medical Magnesium GmbH, Triwo Technopark Aachen, Philipsstraße 8, Aachen, 52068, Germany

8. Stefan Jockenhoevel Aachen Department of Biohybrid and Medical Textiles (BioTex) AME-Institute of Applied Medical Engineering

   RWTH Aachen University

   Affiliation as printed

   Department of Biohybrid & Medical Textiles (BioTex), AME - Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, 52074, Germany

9. Alexander Kopp
   Affiliation as printed

   Embocraft GmbH, Triwo Technopark Aachen, Philipsstraße 8, Aachen, 52068, Germany

   Fibrothelium GmbH, Triwo Technopark Aachen, Philipsstraße 8, Aachen, 52068, Germany

   Meotec GmbH, Triwo Technopark Aachen, Philipsstraße 8, Aachen, 52068, Germany