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.
- Flow Diverter
Data availability statement
Data are available upon reasonable request.
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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.
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