Stroke (Hoboken, N.J.) · 2024
Flow Diversion for Intracranial Aneurysms With Incorporated Branch: A Subanalysis From the SEASE International Registry.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Dibas Mahmoud, Vivanco-Suarez Juan, Galecio-Castillo Milagros, Lopes Demetrius Klee, Hanel Ricardo A, Rodriguez-Calienes Aaron, Cortez Gustavo M, Fifi Johanna T, Devarajan Alex, Toth Gabor, Patterson Thomas E, Altschul David, Pereira Vitor M, Liu Xiao Yu Eileen, Puri Ajit S, Kühn Anna L, Guerrero Waldo R, Khandelwal Priyank, Bach Ivo, Kan Peter T, Edhayan Gautam, Given Curtis, Gross Bradley A, Narayanan Sandra, Derakhshani Shahram, Martinez-Galdamez Mario, Ortega-Gutierrez Santiago
Аннотация
BACKGROUND: The presence of an incorporated branch as well as its anatomical relationship to the intracranial aneurysms (IAs) and the parent artery may affect the occlusion outcome following flow diversion. This study evaluated the safety and effectiveness of the cobalt-chromium Surpass Evolve (Stryker), a 64-wire flow diversion device for the treatment of IAs with incorporated branches.
METHODS: This subanalysis uses data from the SEASE (Safety and Effectiveness Assessment of Surpass Evolve) registry to retrieve data related to IAs with incorporated branches. Those IAs were classified by a core lab into 4 categories based on their anatomical relationship to the parent artery and branch: (A) sidewall anatomic, (B) sidewall hemodynamic, (C) neck branch, and (D) dome branch. We compared the outcomes based on their incorporated branch's relation to the dome (A-C versus D).
RESULTS: This study included 67 patients and IAs. Most IAs were in the posterior communicating artery (46.3%), with a median size of 4.35 mm. Age, sex, comorbidities, baseline functional-status, and IA features were similar between the 2 groups. Among those, 53 (79.1%) had branches emerging from the dome, and 14 (20.9%) had branches originating from other locations (A = 7, B = 2, and C = 5). At a median imaging follow-up of 10.5 months, complete occlusion was lower in IAs with a branch from the sac compared with those with the neck (60.8% versus 92.9%; P = 0.026), with an overall occlusion of 67.7%. Thromboembolic and hemorrhagic complications, as well as retreatment, were reported in 1.6% and 3.1% of cases, respectively, with no significant differences between groups.
CONCLUSION: Our analysis underscores the influence of branch origin on occlusion rates, with the neck-originating branch demonstrating higher occlusion rates. These insights emphasize the role of anatomical considerations in treatment strategies, follow-up timelines, and designing future clinical trials. Further studies are warranted to explore these variations across different flow diversion technologies.
METHODS: This subanalysis uses data from the SEASE (Safety and Effectiveness Assessment of Surpass Evolve) registry to retrieve data related to IAs with incorporated branches. Those IAs were classified by a core lab into 4 categories based on their anatomical relationship to the parent artery and branch: (A) sidewall anatomic, (B) sidewall hemodynamic, (C) neck branch, and (D) dome branch. We compared the outcomes based on their incorporated branch's relation to the dome (A-C versus D).
RESULTS: This study included 67 patients and IAs. Most IAs were in the posterior communicating artery (46.3%), with a median size of 4.35 mm. Age, sex, comorbidities, baseline functional-status, and IA features were similar between the 2 groups. Among those, 53 (79.1%) had branches emerging from the dome, and 14 (20.9%) had branches originating from other locations (A = 7, B = 2, and C = 5). At a median imaging follow-up of 10.5 months, complete occlusion was lower in IAs with a branch from the sac compared with those with the neck (60.8% versus 92.9%; P = 0.026), with an overall occlusion of 67.7%. Thromboembolic and hemorrhagic complications, as well as retreatment, were reported in 1.6% and 3.1% of cases, respectively, with no significant differences between groups.
CONCLUSION: Our analysis underscores the influence of branch origin on occlusion rates, with the neck-originating branch demonstrating higher occlusion rates. These insights emphasize the role of anatomical considerations in treatment strategies, follow-up timelines, and designing future clinical trials. Further studies are warranted to explore these variations across different flow diversion technologies.