New Generation of Flow Diverter (Surpass) for Unruptured Intracranial Aneurysms

Abstract

Background and Purpose— In patients harboring intracranial aneurysms, the major goal in treatment is to prevent bleeding. A new generation of an endoluminal device (Surpass Flow Diverter [Surpass]) was developed to reconstruct parent artery and occlude the aneurysm. We present our clinical and angiographic single-center experience. Methods— Patients with a wide range of complex unruptured aneurysms were treated with the Surpass placed in the parent artery and bridging the aneurysm. Clinical and angiographic follow-up were performed at 6 months. Data were prospectively collected. Results— Thirty seven patients (mean age, 56 years; range, 32–79), harboring 49 unruptured aneurysms were treated at our center. All except 1 patient were treated with a single device. Successful delivery of the device was achieved in all patients. All 35 nonbifurcation aneurysm necks were covered completely, whereas 14 bifurcation aneurysms were only partially covered. There was no major periprocedural morbidity or mortality. During follow-up, 4 patients (10.4%) experienced transient neurological deficit. One patient (3%) developed a minor stroke at 4-month follow-up with persistent neurological deficit. Twelve patients had neurological symptoms related to their aneurysm and 7 showed improvement of these symptoms during follow-up. At 6-month follow-up, 29 of 31 aneurysms studied that had complete neck coverage showed a complete occlusion (94%) including 1 case with a 95% to 100% occlusion, whereas 5 of the 10 bifurcation aneurysms were occluded. Conclusions— Our study shows high safety and efficacy profile of a new generation endoluminal device in treatment of complex intracranial aneurysms. Long-term studies of treated bifurcation aneurysms are needed.

A Novel Flow-Diverting Device (Tubridge) for the Treatment of 28 Large or Giant Intracranial Aneurysms: A Single-Center Experience

“…Similarly, the recently introduced Surpass flow diverter (Stryker Neurovascular) was also designed with different structures: The 2.5-mm-diameter device has 48 wires, whereas the 3-and 4-mm devices have 72 wires and the 5-mm device is constructed of 96 wires. 11 Moreover, their users experienced neither the complications of device migration nor incomplete neck coverage due to device shortening as reported in early series. 10,12 We believe that these structural improvements combined with extensive operator expertise (both of our operators had practiced the delivery and deployment of the Tubridge on models and gained full knowledge of the Tubridge characteristics before placing it in humans) reduced the chance of technical adverse events in patients treated with FD.…”

“…5,29,30 However, studies with a long-term follow-up and larger series are necessary. De Vries et al 11 recently reported their 6-month follow-up result, which showed a complete occlusion (94%), including 1 case with a 95%-100% occlusion. However, their research contained a high number of small aneurysms, which may influence the occlusion rate.…”

“…However, antiplatelet regimens still vary in the literatures; the dose, the intervals, and even the main drug used are different. 11,13,18,19,23,24 Our regimen is modified according to our previous experience of intracranial stent placement, which still seems to be safe for Tubridge implantation. However, multicenter randomized trials with larger subject numbers and long-term follow-up studies are necessary.…”

Flow Diverters in the Treatment of Pediatric Cerebrovascular Diseases

“…For aneurysm treatment, flow diverters were deployed using previously described techniques [12][13][14] after meticulous measurement of the parent artery size at the proximal and distal segments of the aneurysm. These measurements were made on DSA images and 3D images reconstructed from rotational angiograms on workstations of biplane angiography units (Artis zee; Siemens, Erlangen, Germany).…”

In Vitro Evaluation of Intra-Aneurysmal, Flow-Diverter-Induced Thrombus Formation: A Feasibility Study

“…Clinical studies report that the aneurysm is never closed by a thrombus at end-of-procedure angiographythat is, after 1 or 2 hours, 23,24 while at 6-month follow-up angiography, complete occlusion was found in 68%-94% of patients. 23,[25][26][27][28][29][30][31] Although it is difficult to judge when the thrombus formation begins in patients, we suppose that the process is strongly accelerated in the in vitro setup, which potentially influences clotting mechanisms. Dosed anticoagulation by means of Clexane aimed to allow the in vitro use of blood for several hours and does not depict the clinical standard of antiplatelet therapy with aspirin and clopidogrel.…”