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Introduction Flow Re-Direction Endoluminal Device X (FRED TM-X, MicroVention, Inc., Terumo Corporation, USA), introduces a dual-layer structure and antithrombotic surface technology, designed to address the limitations of earlier devices in reducing material thrombogenicity and promoting better vessel endothelialization for brain aneurysm.Aim of study We present the first systematic review and meta-analysis summarizing available literature to reach a consensus regarding the safety and effectiveness of FRED TM-X.Method A literature search was performed for studies that evaluated FRED-X in managing intracranial aneurysms. Proportions were pooled employing the inverse variance method, and binary outcomes were analyzed using odds ratio (OR) and 95% confidence interval (CI). The primary outcome of the measure was an aneurysm occlusion at the final follow-up.Results Eight studies involving 709 patients and 728 aneurysms were included. Most aneurysms were unruptured (87.3%, 95%CI=77.3% – 95%) and located in anterior circulation (85.1%, 95%CI= 73.9% – 93.8%), primarily in internal carotid artery (67.5%). Procedural data showed mean procedure time of 68.2 (SD=38.1) minutes and a fluoroscopy time of 23.5 (SD=11.7) minutes. Mean aneurysm size was 6.4 mm (SD = 5.1). In-stent stenosis occurred in 1.2% of cases. Adequate occlusion was achieved in 81.6% (95%CI=76.9% – 85.9%) of patients at last follow-up. Symptomatic complications occurred in 5.1% (95%CI=2.2% – 8.8%) of patients, and mortality rate was 0.07% (95%CI=0.0% – 0.72%).Conclusion FRED-X flow diverter is safe and effective in treating intracranial aneurysms. It has low complication rates, minimal in-stent stenosis, and efficient procedural metrics. Long-term studies must confirm its durability and potential for broader applications.Conflict of Interest No