Purpose Flow diverters have become a safe and well-accepted treatment option for intracranial aneurysms of most sizes in the anterior and posterior circulation. Surpass Evolve (SE, Stryker Neurovascular, Kalamazoo, Michigan, USA) is a new flow diverter that is available in large diameters (2.5–5 mm) and long lengths (12–40 mm), with high radial force and a high in-vitro flow diverting effect irrespective of the parent vessel tortuosity. This is secondary to a consistency in mesh density (15–30 pores/mm2) and a high number of wires (48–64, depending on the device length). SE can be deployed through an 0.027’ microcatheter, allowing easy navigation within tortuous anatomies. We describe device characteristics and mid-term results in the first patients treated with the SE for intracranial aneurysms.
Materials and Methods We included in this report all patients that underwent aneurysm embolization with the SE at two different institutions. Patients’ data was prospectively collected in two databases and reviewed retrospectively. We included adult patients harboring non-ruptured saccular or fusiform intracranial aneurysms with a wide neck (>4 mm) located in the anterior or posterior circulation. Standard dual anti-platelet therapy was started 5 days pre-procedure and continued for at least 6 months. Neurological complications were classified as intra-procedural, early or delayed if they arose within 1, 30 or more than 30 days from treatment, respectively. Neurological complications were considered minor and major if resulting in transient or permanent neurological morbidity, respectively. Clinical status at discharge and follow up was assessed by independent neurologists or neurosurgeons and imaging included MRI angiography (MRA), CT angiography (CTA) and DSA, depending on the institution.
Results The study included 28 patients (23 females, 82%; age range: 36–86, median age: 56) treated between April and November 2019, harboring 29 aneurysms. Twenty-eight aneurysms were saccular and in the anterior circulation. The majority of aneurysms were <12 mm in diameter (18/29, 62%), 8/29 (28%) were large (<25 mm), 2/29 (7%) were giant (>25 mm) and one was fusiform and partially thrombosed (3%). The SE was delivered in all cases via a tri-axial approach with an intermediate catheter and a 0.027’ microcatheter for implant delivery. This low-profile catheter allowed delivery of the implant through the trans-radial route. Thirty-two implants were used (4 in the patient with the fusiform aneurysm) with an average of 1.1 stents/patient. There were no intra-procedural complications. Median clinical and imaging follow up time was 6 months (range: 2–6 months). There were no deaths. Three patients (3/28, 11%) had early minor neurological complications. There was one (4%) early major neurological complication in a patient with a hemispheric stroke on post-op day 4. Two patients had minor delayed neurological complications (2/28, 7%). Complete thrombosis was seen in 16/29 aneurysms (55%, most of those imaged at 6 months), while partial thrombosis was seen in 12/29 aneurysms (41%). Covered side branches were patent in all patient but the one who experienced the stroke.
Conclusion The SE shows excellent navigability while keeping a high flow-diverting effect. Mid-term clinico-radiological results show good efficacy and acceptable safety of the implant.
Disclosures E. Orru: None. H. Rice: 2; C; Medtronic, Stryker, Philips, Penumbra, Microvention. L. De Villiers: None. A. Wakhloo: 1; C; Philips. 2; C; Stryker, Phenox. 3; C; SCENT trial. 4; C; InNeuroCo, EpiEP, Neural Analytics, Rist, Analytics 4 Life, ThrombX. G. Song Chia: None. A. Qureshi: None. T. Krings: 2; C; Stryker, Medtronic, Penumbra. 4; C; Marblehead Inc. V. Pereira: 1; C; Philips Healthcare. 2; C; Stryker, Balt, Cerenovous, Medtronic.
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