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Introduction The Pipeline Vantage Flow Diverter was developed with a novel design aimed at improved delivery, wall apposition, and reduced thrombogenicity. Data on mid-term outcomes remain limited and scrutiny regarding the device has heightend following a U.S. Food and Drug Administration (FDA) recall of the PVED 0.027’ version due to reports of incomplete wall apposition and braid deformation (‘fish-mouthing’).Aim of study In this report we describe mid-term outcomes of a single centre study evaluating the safety and efficacy of the Pipeline Vantage Flow Diverter, expanding on initial findings from earlier short-term series.Method We retrospectively collected data across a single centre on consecutive patients with intracranial aneurysms treated with the Pipeline Vantage Flow Diverter. Key endpoints included procedure-related technical success, complications, and mid-term radiological occlusion rates.Results A total of 58 patients underwent 58 treatments for 78 aneurysms with the Pipeline Vantage Flow Diverter. Imaging follow-up at a median of 19 (IQR 6; Range: 1–42) months revealed RROC1 (83.1%) followed by RROC2 (8.5%), RROC3a (5.1%), and RROC3b (3.4%). Favourable occlusion occurred in 54 (91.5%). None required retreatment. Procedure related mortality was 0%. There were five (8.2%) ischaemic events and one (1.6%) intracranial haemorrhage, causing persisting neurological deficit in three (4.9%) and transient deficit in three (4.9%). Subset analysis showed no difference in imaging outcomes or adverse events in those treated with the 0.021’ versus 0.027’ system.Conclusion In this mid-term evaluation, the Pipeline Vantage Flow Diverter demonstrated high rates of aneurysm occlusion with an acceptable safety profile.Conflict of Interest No