Article Text
Abstract
Introduction/Purpose Tortuous cavernous internal carotid artery (ICA) segments can significantly augment neurointerventional procedural complexity. Lin et al previously classified ICA genus as a predictor of procedural complexity in Pipeline embolization device (PED, Medtronic Neurovascular) for treatment of intracranial aneurysms, with noted average fluoroscopy times of 44.9±34.1 minutes in moderate (Type II-III) cavernous tortuosity and 52.6±17.2 minutes in severe (Type IV) grades. Here, we characterize the difference in fluoroscopy times between ICA aneurysms managed with Surpass Evolve (Stryker Neurovascular) versus PED in the setting of moderate (Type II-III) to severe (Type IV) cavernous tortuosity.
Methods We retrospectively reviewed a prospectively maintained IRB database of the senior authors to identify cases of ICA aneurysms managed with Surpass Evolve that had a Type II-III or IV cavernous grade. Demographic and periprocedural data were collected and analyzed.
Results Over a 42-month study period, 47 patients (49 cases) underwent Surpass Evolve flow diversion (FD) embolization. 31 cases had a Type II-III cavernous grade (mean age 63±2 years, 90% female), with average aneurysm size of 5±0.6 mm across supraclinoid (n=10, 32%), ophthalmic (n=8, 26%), paraophthalmic/clinoidal (n=8, 26%), ICA terminus (n=3, 10%), and cavernous (n=2, 6%) locations. 18 cases had a Type IV grade (mean age 54±3 years, 89% female), with average aneurysm size of 5.5±0.8 mm across supraclinoid ICA (n=5, 28%), ophthalmic (n=4, 22%), paraophthalmic (n=7, 39%), and cavernous ICA (n=2, 11%) locations. Average procedural fluoroscopy time was 32±2 minutes for Type II-III and 38±3 minutes for Type IV cavernous ICA grades treated with Evolve FD, versus 44.9±34.1 minutes (Type II-III, n=29) and 52.6±17.2 minutes (Type IV, n=26) for PED as reported by Lin et al. Two-sample t-tests showed significant differences between fluoroscopy times for Type IV cavernous ICA (p < 0.001).
Conclusion Surpass Evolve FD resulted in significantly lower fluoroscopy times compared to PED, particularly in cases with severe cavernous tortuosity (Type IV), which may suggest potential procedural efficiency benefits in duration and radiation exposure.
Disclosures J. Campos: None. B. Meyer: None. D. Zarrin: None. F. Laghari: None. M. Khan: None. A. Ramesh: None. J. Collard de Beaufort: None. G. Amin: None. T. Bengston: None. N. Beaty: 5; C; proctor, Medtronic Neurovascular, proctor, Stryker Neurovascular, CMO, NeuroMedica. S. Suzuki: None. M. Bender: 5; C; proctor, Stryker Neurovascular. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Rapid Medical, Cerovenus, Stryker Neurovascular. A. Coon: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Cerovenus, Rapid Medical, Avail MedSystems, Imperative Care, Deinde, InNeuroCo, Q’apel. 5; C; proctor, Medtronic Neurovascular, proctor, Stryker Neurovascular, proctor, MicroVention-Terumo.