title: Surpass Flow Diverter for Treatment of Posterior Circulation Aneurysms.
abstract: Flow diverters for the treatment of posterior circulation aneurysms remain controversial. We aimed to identify factors contributing to outcome measures in patients treated with the Surpass flow diverter for aneurysms in this location.
  
  
  
  We conducted an observational study of 53 patients who underwent flow-diverter treatment for posterior circulation aneurysms at 15 centers. Key outcome measures were mortality, complete aneurysm occlusion, and modified Rankin Scale score at follow-up.
  
  
  
  At follow-up (median, 11.3 months; interquartile range, 5.9-12.7 months), 9 patients had died, resulting in an all-cause mortality rate of 17.3% (95% CI, 7%-27.6%); 7 deaths (14%) were directly related to the procedure and none occurred in patients with a baseline mRS score of zero. After adjusting for covariates, a baseline mRS of 3-5 was more significantly (P= .003) associated with a higher hazard ratio for death than a baseline mRS of 0-2 (hazard ratio, 17.11; 95% CI, 2.69-109.02). After adjusting for follow-up duration, a 1-point increase in the baseline mRS was significantly (P< .001) associated with higher values of mRS at follow-up (odds ratio, 2.93; 95% CI, 1.79-4.79). Follow-up angiography in 44 patients (median, 11.3 months; interquartile range, 5.9-12.7 months) showed complete aneurysm occlusion in 29 (66%; 95% CI, 50.1%-79.5%).
  
  
  
  Clinical results of flow-diverter treatment of posterior circulation aneurysms depend very much on patient selection. In this study, poorer outcomes were related to the treatment of aneurysms in patients with higher baseline mRS scores. Angiographic results showed a high occlusion rate for this subset of complex aneurysms.
authors.affiliation: From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany christian.taschner@uniklinik-freiburg.de.
authors.forename: C A
authors.identifier: 0000-0002-8921-179X
authors.initials: CA
authors.lastname: Taschner
authors.affiliation: Department of Radiology (S.V.).
authors.forename: S
authors.identifier: 0000-0003-4123-8392
authors.initials: S
authors.lastname: Vedantham
authors.affiliation: Department of Neurosurgery (J.d.V., J.B.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: J
authors.identifier: 0000-0002-3587-2103
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Department of Neuroradiology and Endovascular Therapy (A.B.), University of Besançon, Besançon, France.
authors.forename: A
authors.identifier: 0000-0002-3185-0740
authors.initials: A
authors.lastname: Biondi
authors.affiliation: From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany.|Department of Neurosurgery (J.d.V., J.B.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: J
authors.identifier: 0000-0001-5855-2447
authors.initials: J
authors.lastname: Boogaarts
authors.affiliation: Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: N
authors.identifier: 0000-0002-3289-1210
authors.initials: N
authors.lastname: Sakai
authors.affiliation: Department of Neurosurgery (P.L.), Equipo de Neurocirugía Endovascular Radiología Intervencionista, Buenos Aires, Argentina.
authors.forename: P
authors.identifier: 0000-0001-7044-4369
authors.initials: P
authors.lastname: Lylyk
authors.affiliation: National Institute of Neurosciences (I.S.), Budapest, Hungary.
authors.forename: I
authors.identifier: 0000-0003-3730-3278
authors.initials: I
authors.lastname: Szikora
authors.affiliation: From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany.
authors.forename: S
authors.identifier: 0000-0001-6468-4526
authors.initials: S
authors.lastname: Meckel
authors.affiliation: From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany.
authors.forename: H
authors.identifier: 0000-0001-7264-4807
authors.initials: H
authors.lastname: Urbach
authors.affiliation: Department of Neurosurgery (P.K.), Baylor College of Medicine, Houston, Texas.
authors.forename: P
authors.identifier: 0000-0002-6224-097X
authors.initials: P
authors.lastname: Kan
authors.affiliation: Department of Neuroradiology (R.S.), Klinikum Kassel, Kassel, Germany.
authors.forename: R
authors.identifier: 0000-0001-7788-1510
authors.initials: R
authors.lastname: Siekmann
authors.affiliation: From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany.
authors.forename: J
authors.identifier: 0000-0002-2669-8086
authors.initials: J
authors.lastname: Bernardy
authors.affiliation: New England Center for Stroke Research (M.J.G.).
authors.forename: M J
authors.identifier: 0000-0002-8034-2785
authors.initials: MJ
authors.lastname: Gounis
authors.affiliation: Division of Neuroimaging and Intervention (A.K.W.), Departments of Radiology, Neurology, and Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: A K
authors.identifier: 0000-0003-2126-4155
authors.initials: AK
authors.lastname: Wakhloo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult