Treatment of unruptured small and medium-sized wide necked aneurysms using the 64-wire Surpass Evolve: A subanalysis from the SEASE International Registry

Mahmoud Dibas, Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA.
Juan Vivanco-Suarez, Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA.
Demetrius K. Lopes, Advocate Health - MidwestFollow
Ricardo A. Hanel, Lyerly Neurosurgery Baptist Neurological Institute Jacksonville FL.
Aaron Rodriguez-Calienes, Neuroscience, Clinical Effectiveness and Public Health Research Group Universidad Científica del Sur Lima Peru.
Gustavo M. Cortez, Lyerly Neurosurgery Baptist Neurological Institute Jacksonville FL.
Johanna T. Fifi, Department of Neurological Surgery Mount Sinai Health System New York NY.
Alex Devarajan, Department of Neurological Surgery Mount Sinai Health System New York NY.
Gabor Toth, Cerebrovascular Center, Neurological Institute Cleveland Clinic Cleveland OH.
Thomas E. Patterson, Cerebrovascular Center, Neurological Institute Cleveland Clinic Cleveland OH.
David Altschul, Department of Neurological Surgery, Montefiore Medical Center Albert Einstein College of Medicine Bronx NY.
Vitor M. Pereira, Department of Neurosurgery St Michael's Hospital Toronto ON Canada.
Xiao Y. Liu, Department of Neurosurgery St Michael's Hospital Toronto ON Canada.
Ajit S. Puri, Department of Radiology, Division of Neurointerventional Radiology University of Massachusetts Chan Medical School Worcester MA.
Anna L. Kühn, Department of Radiology, Division of Neurointerventional Radiology University of Massachusetts Chan Medical School Worcester MA.
Waldo R. Guerrero, Department of Neurology and Brain Repair University of South Florida Tampa FL.
Priyank Khandelwal, Department of Neurological Surgery Robert Wood Johnson University Hospital Newark NJ.
Ivo Bach, Department of Neurological Surgery Robert Wood Johnson University Hospital Newark NJ.
Peter T. Kan, Department of Neurosurgery University of Texas Medical Branch Galveston TX.
Gautam Edhayan, Department of Neurosurgery University of Texas Medical Branch Galveston TX.
Mario Martinez-Galdamez, Department of Interventional Neuroradiology Hospital Clínico Universitario de Valladolid Valladolid Spain.
Curtis Given, Department of Radiology Baptist Health Lexington Lexington KY.
Bradley A. Gross, Department of Neurosurgery University of Pittsburgh Pittsburgh PA.
Sandra Narayanan, Pacific Neuroscience Institute Santa Monica CA.
Milagros Galecio-Castillo, Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA.
Shahram Derakhshani, Department of Diagnostic and Therapeutic Neuroradiology, Essex Center for Neurological Sciences Queen's University Hospital Romford London UK.
Santiago Ortega-Gutierrez, Department of Neurology, Neurosurgery and Radiology University of Iowa Hospitals and Clinics Iowa City IA.

Affiliations

Brain & Spine Institute, Park Ridge

Abstract

Background:Flow diversion has revolutionized the management of wide-necked intracranial aneurysms (IAs). We aimed to assess the effectiveness and safety of the new generation 64-wire Surpass Evolve for the treatment of unruptured small/medium-sized IAs.

Methods and results:This is a subanalysis from the SEASE (Safety and Effectiveness Assessment of the Surpass Evolve) registry, an observational cohort study including 15 academic institutions in North America and Europe between July 2020 and October 2022. Patients with wide-necked saccular IAs, measuring <12 mm along the internal carotid artery and vertebrobasilar system, and treated with the Surpass Evolve were included. Primary effectiveness was complete occlusion (Raymond-Roy class 1) at follow-up (core laboratory adjudicated), and primary safety was major stroke (ischemic/hemorrhagic) in the territory supplied by the target artery or death. A total of 129 cases with 135 IAs were included (median age 59 years, 85.3% women). Median maximum IAs size and neck size were 5.1 and 3.9 mm, respectively. Most IAs were in the internal carotid artery C6 (65.9%, 89/135) and C7 (14.1%, 19/135) segments. At a median follow-up time of 10.2 months (interquartile range, 6.4-12.8), complete occlusion was 77.1% (101/131), ≥50% in-stent stenosis was 8.8% (11/125), and retreatment was 0.8% (1/125). Major stroke and mortality were reported in 2 (1.6%) patients and 1 (0.8%) patient, respectively. Size was the only factor associated with higher odds of incomplete occlusion (adjusted odds ratio, 1.2 [95% CI, 1.02-1.5]; P=0.03).

Conclusions:Patients with small/medium-sized IAs can be effectively treated using the Surpass Evolve, a new generation, 64-wire, cobalt-chromium flow diverter.

Document Type

Article

PubMed ID

39450745

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