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Abstract
Introduction The use of flow diversion for the treatment of intracranial aneurysm has gained broad acceptance. Three flow diverting stents are approved by the FDA for use in the United States. We sought to compare the outcomes and safety profiles between the three devices at our institution.
Methods A retrospective review of aneurysms treated with pipeline embolization device(PED), Flow-Redirectional Endoluminal Device(FRED) and Surpass was performed for aneurysms treated between 2018-2022 at our institution.
Results The study cohort consisted of 142 patients. 86 aneurysms were treated with pipeline, 33 aneurysm treated with FRED and 23 aneurysms treated with SURPASS. The 1 year complete occlusion rates were 59.4%, 60% and 65% respectively(0.91). Linear regression models found that only adjunctive coiling predicted aneurysm occlusion at 6 months (p=.02), but this effect was lost at 1-year and beyond. There was no significant difference in acute thrombotic or acute hemorrhagic complications between the three cohorts. There was a higher rate of delayed hemorrhagic complications in the SURPASS cohort(10%) compared to the PED(1.3%) and FRED(0%) cohorts(p=0.04). There was also a higher rate of in-stent stenosis in the SURPASS cohort(20%) compared to the PED(5%) and FRED(3.1%) cohorts(p<0.01).
Discussion Treatment with PED, FRED and SURPASS all resulted in similar complete occlusion rates at 6 months and 1 year. SURPASS was associated with higher in-stent stenosis as well as delayed hemorrhagic complications. Additional future studies evaluating the newest generation of flow diverting stents with long term follow up will be necessary to make any definitive conclusions.
Occlusion data for the three groups and complication rates between the three cohorts. Acute-48 hours, delayed>48 hours
Three paraophthalmic aneurysms treated with flow diverting stents. A) Preoperative lateral angiogram B) 6 month follow up after placement of FRED stent. There is complete occlusion of the aneurysm with mild in-stent stenosis of the distal stent C) Preoperative lateral angiogram D) 6 month follow up after placement of PED with complete occlusion of the aneurysm E) Preoperative lateral angiogram F) 6 month followup after placement of SURPASS stent with complete occlusion of the aneurysm and no evidence of in-stent stenosis
Disclosures A. Paul: None. N. Field: None. J. Dalfino: None. A. Custozzo: None. A. Boulos: None.