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Introduction: Surface modifications to newer flow-diverting stents have been developed to improve biocompatibility and decrease thrombogenicity. This study evaluated dual antiplatelet dosing strategies in patients with intracranial aneurysms treated using the Pipeline™ Flex device with Shield Technology™. Methods: This was a single center, retrospective chart review of adult patients treated with Pipeline TM Flex Embolization Device with Shield Technology TM from March 1, 2021 to June 1, 2024. Eligible participants were adults (≥ 18 years) who received the Pipeline™ Flex device with Shield Technology™. Exclusion criteria included pregnancy and incarceration. Patients were placed into one of two groups based on their discharge DAPT regimen. The primary outcome was the incidence and severity of thromboembolic events within 3 to 6 months on standard vs alternative dosing DAPT. Secondary outcomes included hospital readmission and death within three to six months of procedure. Results: Forty patients were included (standard n= 23, alternative n=17). Baseline characteristics were similar, with a median age of 59 years and 85% female. Ruptured aneurysms occurred in 39.1% of the standard group versus 23.5% of the alternative group. Among those with rupture, 66.6% in the standard group had a Hunt and Hess score ≥3, compared to 0% in the alternative group. In the standard group the most common DAPT regimen was aspirin plus clopidogrel 75 mg daily (100%), while the most common regimen in the alterative group was clopidogrel 75 mg every other day (64.7%). No significant differences were observed in the primary outcome of thromboembolic events at 3–6 months (4.3% vs. 11.8%, p=0.5647). No significant differences were found in any secondary outcomes. Conclusions: Using standard or alternative DAPT regimens (directed by VerifyNow tests) in patients with the Pipeline TM Flex Embolization Device with Shield Technology TM demonstrated similar safety and efficacy outcomes. Further research on DAPT dosing strategies with the Pipeline TM Flex device, and other new generation flow diverting stents, is needed to determine their effect on patient outcomes.