1Jagadeesan Dhanasekaran,1Venkatesh Pothula, 1Santhosh Joseph

1Sri Ramachandra Institute of Higher Education and Research

Background(s):

Flow diverter (FD) have become a safe treatment option for intracranial aneurysms (IA), especially in fusiform and blister like aneurysms which remained challenging. Newer generation Surpass Evolve (SE) is a FD that was approved for usage since 2019 in India.

The aim of this study is to describe the initial experience and analyse the angiographic and clinical outcomes using SE in treatment of IA.

Material(s) and Method(s):

Between December 2019 to December 2021, forty four IA in 36 patients (69.4% women), mean age 51 years were treated with SE in our institute. Baseline patient clinical details, aneurysm demographics and treatment modalities were prospectively collected and results were reviewed.

Result(s):

IA was noted as an incidental finding in 69.4% patients, majority (75%) were saccular and 70% were wide necked. Apart from re-sheathing of FD, four patients required balloon angioplasty of deployed FD. Adjuvant coiling was performed in six aneurysms and two aneurysms required an extra FD to achieve proper wall apposition. Mean Aneurysm Flow Amplitude (MAFA) – Ratio obtained in 2 patients showed superior flow diversion effect of SE device. There were thromboembolic complications in two patients, which were managed successfully. We had few early reversible neurological complications and one mortality. Favourable aneurysm occlusion /O’Kelly-Marotta (OKM) grading scale D was achieved in 18/20 (90%) patients on follow-up. No FD deployment failure, intra-procedural mortality, increase in the mRS was observed.

Conclusion(s):

SE worked technically well in terms of its excellent navigability, re-sheathing, accuracy of placement and maximal flow diversion. Our initial clinical and angiographic results show good efficacy comparable to other FD.