Surpass Flow Diverter in the Treatment of Ruptured Intracranial Aneurysms–A Single-Center Experience

Mahajan, Anshu; Das, Biplab; Narang, Kushal; Jha, Ajaya Nand; Singh, Vinod P.; Sapra, Harsh; Goel, Gaurav

doi:10.1016/j.wneu.2018.09.011

Cited by 13 publications

(6 citation statements)

References 22 publications

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“…Finally, one single-center analysis investigated the feasibility of Surpass use in patients with acutely ruptured aneurysms. In 16 patients with 16 aneurysms, 15 achieved a favorable clinical outcome (mRS 0–1) at 3 months, one patient died of an invasive fungal infection, and angiographic follow-up showed no filling in 13 of 15 cases at 3 and 6 months 14. Together, these previous studies demonstrate the broad utility of the Surpass device, similar to the 1-year findings of the SCENT trial.…”

Section: Discussionsupporting

confidence: 61%

Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms – SCENT: 3-year outcomes

Hanel

Cortez

Coon

et al. 2022

J NeuroIntervent Surg

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BackgroundTo report the 3-year safety and effectiveness of the Surpass Streamline flow diverter in the SCENT trial (Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms).MethodsThe Surpass Streamline flow diverter device was evaluated in a multicenter, prospective, single-arm, non-randomized interventional trial including patients with uncoilable or previously treated but failed aneurysms of the intracranial internal carotid artery. 3-year outcomes were tabulated with descriptive statistics and compared with 1-year outcomes.ResultsOf 180 patients in the modified intent-to-treat (mITT) cohort, 36-month clinical and angiographic follow-up was available in 134 and 117 cases, respectively. Effectiveness endpoint of complete aneurysm occlusion without clinically significant stenosis or retreatment was met in 71.8% (79/110, 95% CI 62.4% to 80.0%) of cases. Safety composite endpoint was 12.2% (22/180) over the 3-year period, with two major safety events (ipsilateral ischemic strokes) occurring between 12–36 months. Complete aneurysm occlusion was noted in 77.8% (91/117), and 99.1% (116/117) of the patients demonstrated adequate aneurysm occlusion (complete occlusion or neck residual). There were four cases (2.2%) of aneurysm rupture, all occurring within the first month of the index procedure. Target aneurysm retreatment rate was 2.8% (5/180).ConclusionThe present findings support the long-term safety and effectiveness of the Surpass Streamline flow diverter device.Trial registrationNCT01716117.

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Section: Discussionsupporting

confidence: 61%

Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms – SCENT: 3-year outcomes

Hanel

Cortez

Coon

et al. 2022

J NeuroIntervent Surg

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“…These results are comparable to those in different published series on ruptured aneurysms treated with FDSs. A meta-analysis reported complete/near-complete occlusion in 89% of patients at a mean 9.6-month follow-up, 2 Goertz et al 4 found complete occlusion in 89% of treated aneurysms after 6 months, Mahajan et al 6 reported complete angiographic occlusion in 87% of cases after 6 months, and Lozupone et al 5 had an 80% complete angiographic occlusion rate at 6 months. These consistently observed occlusion rates compare favorably to the results obtained in ruptured aneurysms treated with coiling.…”

Section: Discussionmentioning

confidence: 99%

“…From an operative point of view, these two factors are particularly important when dealing with ruptured aneurysms in which endovascular therapy is performed on an urgent basis. Recently, Parthasarathy et al 20 and Mahajan et al 6 reported the use of a loading dose of 150 mg of aspirin and 50 mg of prasugrel 2 hours prior to the procedure. They used prasugrel instead of clopidogrel, with timing optimized for platelet inhibition.…”

Section: Discussionmentioning

confidence: 99%

“…2 However, rates of thromboembolic and hemorrhagic complications in recent studies remain high, ranging from 2.2% to 10%, and overall complications range from 6% to 24% (Table 1). [1][2][3][4][5][6] There were wide variations in patient management strategies in these reports, including diverse antiplatelet regimens (Table 2), an important factor influencing the rate of hemorrhagic complications. Here, we present our experience with the use of FDSs in the treatment of acutely ruptured aneurysms, focusing on the external ventricular drainage (EVD) strategy, antiplatelet regimen, perioperative management, patient outcomes, and complications.…”

mentioning

confidence: 99%

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Flow-diverter stents in the early management of acutely ruptured brain aneurysms: effective rebleeding protection with low thromboembolic complications

Cohen¹,

Gomori

Moscovici³

et al. 2021

Journal of Neurosurgery

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OBJECTIVE Flow-diverter stents (FDSs) are not generally used for the management of acutely ruptured aneurysms with associated subarachnoid hemorrhage (SAH). Herein, the authors present their experience with FDSs in this scenario, focusing on the antiplatelet regimen, perioperative management, and outcome. METHODS The authors retrospectively reviewed their institutional database for the treatment and outcomes of all patients with acutely ruptured aneurysms and associated SAH from July 2010 to September 2018 who had received an FDS implant as stand-alone treatment within 4 days after diagnosis. The protocol with the use of flow diversion in these patients includes a low threshold for placement of external ventricular drains before stenting, followed by the administration of aspirin and clopidogrel with platelet testing before stent implantation. With this approach, the risk of hemorrhage and stent-related thrombus formation is limited. Demographic, clinical, technical, and imaging data were analyzed. RESULTS Overall, 76 patients (61% females, mean age 42.8 ± 11.3 years) met the inclusion criteria. FDS implantation was performed a median of 2 days after diagnosis. On average, 1.05 devices were used per procedure. There was no procedural mortality directly attributed to the endovascular intervention. Procedural device-related clinical complications were recorded in a total of 6 cases (7.9%) and resulted in permanent neurological morbidity in 2 cases (2.6%). There was complete immediate aneurysm occlusion in 11 patients (14.5%), and persistent aneurysm filling was seen in 65 patients (85.5%). Despite this, no patient presented with rebleeding from the target aneurysm. There was an excellent clinical outcome in 62 patients (81.6%), who had a 90-day modified Rankin Scale score of 0–2. Among the 71 survivors, total or near-total occlusion was observed in 64/67 patients (95.5%) with a 3- to 6-month angiographic follow-up and in all cases evaluated at 12 months. Five patients (6.6%) died during follow-up for reasons unrelated to the procedure or new hemorrhage. CONCLUSIONS Flow diversion is an effective therapeutic strategy for the management of select acutely ruptured aneurysms. Despite low rates of immediate aneurysm occlusion after FDS implantation, the device exerts an important protective effect. The authors’ experience confirmed no aneurysm rerupture, high rates of delayed complete occlusion, and complication rates that compare favorably with the rates obtained using other techniques.

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“…So far, 12 case series of ruptured dissecting aneurysms or ruptured blood blister-like aneurysms treated in acute phase with flow diverter have been reported. [13][14][15][16][17][18][19][20][21][22][23][24] In these reports, 115 ruptured site (68 internal carotid artery, six middle cerebral artery, one anterior cerebral artery, 26 vertebral artery, six basilar artery, two posterior cerebral artery, three anterior inferior cerebellar artery, three posterior inferior cerebellar artery) were treated; 101 were treated with only flow diverter, 14 with flow diverter and coil. In these 115 cases, no rebleeding from ruptured site and 10 symptomatic thrombotic events were observed after procedure.…”

Section: Discussionmentioning

confidence: 99%

Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

Sonobe

Yoshida

Niizuma

et al. 2020

NMC Case Report Journal

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The diagnosis and treatment of patients with ruptured basilar artery dissection (rBAD) are often difficult. We present a case of rBAD diagnosed with magnetic resonance vessel wall imaging (MR-VWI) and treated with coil embolization with overlapping low-profile visualized intraluminal support (LVIS) stents. The case is of a 49-year-old woman with subarachnoid hemorrhage. digital subtraction angiography (DSA) showed irregularity in an anterior wall of the middle portion of the basilar artery, indicating the presence of a false lumen. MR-VWI showed local enhancement in an arterial wall, which was consistent with the wall irregularity observed in DSA. Overlapping stents (two LVIS stents) was performed in the basilar artery and coils were placed in the false lumen. The false lumen was completely thrombosed, and anterograde blood flow of the basilar artery was preserved. Dual antiplatelet therapy was administered, and the patient underwent an uneventful postoperative course. DSA performed 6 months later showed a white-collar sign. MR-VWI has attracted attention as a useful modality for detecting a ruptured lesion in patients with subarachnoid hemorrhage. This is the first report, to the best of our knowledge, describing the practical use of MR-VWI for rBAD. MR-VWI is suggested to improve diagnostic accuracy for rBAD. There are no established treatments for rBAD; reconstructive endovascular treatments comprising stent placement and coil embolization of a false lumen are promising. The LVIS stent has a braided design and high metal coverage ratio and is considered to be reasonable for use in rBAD. Coil embolization of a false lumen with overlapping LVIS stents may be effective for rBAD.

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Surpass Flow Diverter in the Treatment of Ruptured Intracranial Aneurysms–A Single-Center Experience

Cited by 13 publications

References 22 publications

Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms – SCENT: 3-year outcomes

Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms – SCENT: 3-year outcomes

Flow-diverter stents in the early management of acutely ruptured brain aneurysms: effective rebleeding protection with low thromboembolic complications

Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

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