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Original research
Treatment of large and giant posterior communicating artery aneurysms with the Surpass streamline flow diverter: results from the SCENT trial
  1. Peter Kan1,
  2. Alina Mohanty2,
  3. Philip M Meyers3,
  4. Alexander L Coon4,
  5. Ajay K Wakhloo5,
  6. Miklos Marosfoi6,
  7. Mark Bain7,
  8. Joost de Vries8,
  9. Koji Ebersole9,
  10. Giuseppe Lanzino10,
  11. Philipp Taussky11,
  12. Ricardo A Hanel12
  1. 1Department of Neurosurgery, The University of Texas Medical Branch at Galveston School of Medicine, Galveston, Texas, USA
  2. 2Baylor College of Medicine Department of Neurosurgery, Houston, Texas, USA
  3. 3Radiology and Neurological Surgery, Columbia University, New York, New York, USA
  4. 4Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
  5. 5Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
  6. 6Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
  7. 7Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
  8. 8Radboud Universiteit, Nijmegen, Gelderland, Netherlands
  9. 9Neurosurgery, Radiology, University of Kansas, Kansas City, Kansas, USA
  10. 10Mayo Clinic, Rochester, Minnesota, USA
  11. 11Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
  12. 12Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
  1. Correspondence to Dr Peter Kan, Department of Neurosurgery, The University of Texas Medical Branch at Galveston School of Medicine, 301 University Blvd, Galveston, Texas 77555, USA; ptkan{at}utmb.edu

Abstract

Background The Surpass flow diverter was developed to treat intracranial aneurysms not amenable to standard treatment. Indications for use allow placement in the internal carotid artery to the terminus, including the communicating artery segment.

Methods The Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide Neck Aneurysms (SCENT) trial is an international, multicenter, prospective, non-randomized trial comparing the outcomes of Surpass flow diverter treatment with historic control designed to evaluate the effectiveness and safety of Surpass for the treatment of wide neck (≥4 mm) large or giant intracranial aneurysms ≥10 mm. The primary effectiveness endpoint is the percentage of subjects with 100% aneurysm occlusion without significant stenosis of the parent artery and without retreatment of the target aneurysm at 12 months. The primary safety endpoint is the percentage of subjects experiencing neurologic death or major ipsilateral stroke at 12 months. We report the effectiveness and safety of flow diversion in the subgroup of posterior communicating artery (PComA) aneurysms.

Results Of the 180 patients treated, 38 harbored a PComA aneurysm. Mean aneurysm size was 12.2 mm and mean neck width was 4.8 mm. The mean number of Surpass devices used was 1.1 per procedure, with 94.7% of aneurysms treated with one flow diverter. The 12 month primary effectiveness rate was 73.7% (28/38). At 36 months, 68.4% (26/38) of aneurysms remained completely occluded. The 12 month major ipsilateral stroke or neurological death rate was 10.5%. No patients with PComA occlusion after flow diverter placement (54.5%) had clinical sequelae.

Conclusions SCENT demonstrated acceptable 12 month effectiveness of flow diversion in PComA aneurysms. Despite associated PComA occlusions in many cases, arterial occlusions were clinically silent.

Trial registration number URL: https://www.clinicaltrials.gov. Unique identifier: NCT01716117.

  • Aneurysm
  • Brain
  • Flow Diverter

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @PeterKa80460001, @dralexandercoon

  • Contributors PK and RAH implemented the trial, cleaned and analyzed the data, and drafted and revised the paper. He is the guarantor. AM also cleaned and analyzed the data, and drafted and revised the paper. PMM, ALC, MM, MB, KE, GL, and PT implemented the trial, analyzed the data, and revised the paper. AKW implemented the trial, analyzed the data, and drafted and revised the paper. JD implemented the trial in the Netherlands, analyzed the data, and revised the paper.

  • Funding The SCENT (Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide Neck Aneurysms) was sponsored by Stryker Neurovascular.

  • Competing interests PK: consultant for Stryker and Cerenovus, and stockholder of InNeuroCo; editorial board member of Journal of NeuroInterventional Surgery; and education chair of the Society of NeuroInterventional Surgery. PMM: consultant for Stryker, Medtronic, and Penumbra. ALC: consultant for Stryker, Medtronic, Microvention, and InNeuroCo. AKW: research grant from Philips Medical; serves as a consultant for Stryker; is a stockholder of InNeuroCo, NovaSignal, Rist, Analytics 4 Life, and ThrombX; and is on the speakers’ bureau for the SCENT trial (Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide Neck Aneurysms) presentations. JD: consultant for Stryker and Evasc. KE: consultant for Stryker and Microvention. RAH: research grant from Medtronic, Stryker, Microvention, and Cerenovus; consultant for Stryker, Medtronic, Cerenovus, and Microvention; stockholder in Neurvana, Elum, EndoStream, Three Rivers Medical Inc, Rist, Cerebrotech, and InNeuroCo; scientific advisor for MIVI, Elum, Three Rivers Medical Inc, and Shape Medical. PT: consultant for Medtronic, Cerenovus, and Stryker.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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