title: Surpass flow diverter in the treatment of intracranial aneurysms: a prospective multicenter study.
abstract: OBJECTIVE
  Incomplete occlusion and recanalization of large and wide-neck brain aneurysms treated by endovascular therapy remains a challenge. We present preliminary clinical and angiographic results of an experimentally optimized Surpass flow diverter for treatment of intracranial aneurysms in a prospective, multicenter, nonrandomized, single-arm study.
  
  
  METHODS
  At 24 centers, 165 patients with 190 intracranial aneurysms of the anterior and posterior circulations were enrolled. The primary efficacy end point was the percentage of intracranial aneurysms with 100% occlusion on 6-month DSA. The primary safety end point was neurologic death and any stroke through a minimum follow-up of 6 months.
  
  
  RESULTS
  Successful flow-diverter delivery was achieved in 161 patients with 186 aneurysms (98%); the mean number of devices used per aneurysm was 1.05. Clinical follow-up (median, 6 months) of 150 patients (93.2%), showed that the primary safety end point occurred in 18 subjects. Permanent neurologic morbidity and mortality were 6% and 2.7%, respectively. Morbidity occurred in 4% and 7.4% of patients treated for aneurysms of the anterior and posterior circulation, respectively. Neurologic death during follow-up was observed in 1.6% and 7.4% of patients with treated intracranial aneurysms of the anterior and posterior circulation, respectively. Ischemic stroke at ≤30 days, SAH at ≤7 days, and intraparenchymal hemorrhage at ≤7 days were encountered in 3.7%, 2.5%, and 2.5% of subjects, respectively. No disabling ischemic strokes at >30 days or SAH at >7 days occurred. New or worsening cranial nerve deficit was observed in 2.7%. Follow-up angiography available in 158 (86.8%) intracranial aneurysms showed 100% occlusion in 75%.
  
  
  CONCLUSIONS
  Clinical outcomes of the Surpass flow diverter in the treatment of intracranial aneurysms show a safety profile that is comparable with that of stent-assisted coil embolization. Angiographic results showed a high rate of intracranial aneurysm occlusion.
authors.affiliation: From the Division of Neuroimaging and Intervention (A.K.W.), Departments of Radiology, Neurology, and Neurosurgery ajay.wakhloo@umassmemorial.org.
authors.forename: A K
authors.initials: AK
authors.lastname: Wakhloo
authors.affiliation: Department of Neurosurgery (P.L., J.L.), ENERI, Buenos Aires, Argentina.
authors.forename: P
authors.initials: P
authors.lastname: Lylyk
authors.affiliation: Department of Neurosurgery (J.d.V.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Department of Neuroradiology (C.T.), University of Freiburg, Freiburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Taschner
authors.affiliation: Department of Neurosurgery (P.L., J.L.), ENERI, Buenos Aires, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: Lundquist
authors.affiliation: Department of Neuroradiology and Endovascular Therapy (A. Biondi), University of Besançon, Besançon, France.
authors.forename: A
authors.initials: A
authors.lastname: Biondi
authors.affiliation: Department of Neuroradiology (M.H.), Helios Hospital, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hartmann
authors.affiliation: National Institute of Neurosciences (I.S.), Budapest, Hungary.
authors.forename: I
authors.initials: I
authors.lastname: Szikora
authors.affiliation: Department of Neuroradiology (L.P.), Hôpital Maison Blanche, University Hospital of Reims, Reims, France.
authors.forename: L
authors.initials: L
authors.lastname: Pierot
authors.affiliation: Department of Neurosurgery (N. Sakai, H.I.), Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Sakai
authors.affiliation: Department of Neurosurgery (N. Sakai, H.I.), Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Imamura
authors.affiliation: Department of Neuroradiology (N. Sourour), Hôpital Pitié-Salpetrière, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Sourour
authors.affiliation: Department of Neuroradiology (I.R.), The Royal Hospitals, Belfast, Ireland.
authors.forename: I
authors.initials: I
authors.lastname: Rennie
authors.affiliation: Department of Neuroradiology (M.S., O.B.), Universitātsklinikum Magdeburg, Magdeburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Skalej
authors.affiliation: Department of Neuroradiology (M.S., O.B.), Universitātsklinikum Magdeburg, Magdeburg, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Beuing
authors.affiliation: Department of Neuroradiology (A. Bonafé), Hôpital Guy de Chauillac, Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Bonafé
authors.affiliation: Department of Neurosurgery (F.M.), Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: F
authors.initials: F
authors.lastname: Mery
authors.affiliation: Department of Neuroradiology (F.T.), Hôpital Neurologique, Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Turjman
authors.affiliation: Department of Neuroradiology (P.B.), Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Brouwer
authors.affiliation: Department of Neuroradiology (E.B., L.V.), Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Boccardi
authors.affiliation: Department of Neuroradiology (E.B., L.V.), Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Valvassori
authors.affiliation: Department of Neuroradiology (S.D.), Essex Center for Neurological Sciences, Queen's University Hospital, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Derakhshani
authors.affiliation: Stryker Neurovascular (M.W.L.), Fremont, California.
authors.forename: M W
authors.initials: MW
authors.lastname: Litzenberg
authors.affiliation: New England Center for Stroke Research (M.J.G.), University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: M J
authors.initials: MJ
authors.lastname: Gounis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography / Q000295:instrumentation; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome