title: Flow diversion of large internal carotid artery aneurysms with the surpass device: impressions and technical nuance from the initial North American experience.
abstract: BACKGROUND
  Flow diversion is an important tool for treatment of cerebral aneurysms, particularly large and giant aneurysms. The Surpass flow diverter is a new system under evaluation in the USA.
  
  
  OBJECTIVE
  To report our initial experience of 20 cases with the Surpass flow diverter to demonstrate its basic properties, the required triaxial delivery platform, and the methodologies used to deploy it during treatment of large internal carotid artery (ICA) aneurysms
  
  
  METHODS
  Twenty patients with ICA aneurysms ≥10 mm with ≥4 mm neck treated as part of the Surpass IntraCranial Aneurysm Embolization System Pivotal Trial (the SCENT trial; Stryker) were included. Details of patient demographics, aneurysm characteristics, and technical procedures were collected.
  
  
  RESULTS
  Twenty patients (mean age 63.3±1.3 years; range 51-72) with 20 unruptured aneurysms (mean size 13.4±0.9 mm; range 10-21 mm) were treated. For proximal access, 60% of cases had aortic arch ≥grade II, 55% had significant cervical ICA tortuosity, and 60% had cavernous ICA ≥grade II. The Surpass device was implanted in 19/20 (95%) cases. Of 19 cases, a single device was used in 18 cases (95%) and 2 devices in only 1 case (5%). Balloon angioplasty was performed in 8/19 cases (42%). Complete aneurysm neck coverage and adequate vessel wall apposition was obtained in all 19 cases.
  
  
  CONCLUSIONS
  Surpass is a next-generation flow diverter with unique device-specific and delivery-specific features compared with clinically available endoluminal flow diverters. Our initial experience demonstrates a favorable technical profile in treatment of large and giant ICA aneurysms.
  
  
  BACKGROUND
  NCT01716117.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Colby
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Li-Mei
authors.initials: LM
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Caplan
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Bowen
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Michniewicz
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Tamargo
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Coon
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology
keywords: Aneurysm; Catheter; Device; Flow Diverter; Stent