Safety and efficacy of the surpass streamline for intracranial aneurysms (SESSIA): A multi-center US experience pooled analysis

Abstract

Background and purpose: Flow diversion has established as standard treatment for intracranial aneurysms, the Surpass Streamline is the only FDA-approved braided cobalt/chromium alloy implant with 72-96 wires. We aimed to determine the safety and efficacy of the Surpass in a post-marketing large United States cohort.

Materials and methods: This is a retrospective multicenter study of consecutive patients treated with the Surpass for intracranial aneurysms between 2018 and 2021. Baseline demographics, comorbidities, and aneurysm characteristics were collected. Efficacy endpoint included aneurysm occlusion on radiographic follow-up. Safety endpoints were major ipsilateral ischemic stroke or treatment-related death.

Results: A total of 277 patients with 314 aneurysms were included. Median age was 60 years, 202 (73%) patients were females. Hypertension was the most common comorbidity in 156 (56%) patients. The most common location of the aneurysms was the anterior circulation in 89% (279/314). Mean aneurysm dome width was 5.77 ± 4.75 mm, neck width was 4.22 ± 3.83 mm, and dome/neck ratio was 1.63 ± 1.26. Small-sized aneurysms were 185 (59%). Single device was used in 94% of the patients, mean number of devices per patient was 1.06. At final follow-up, complete obliteration rate was 81% (194/239). Major stroke and death were encountered in 7 (3%) and 6 (2%) cases, respectively.

Conclusion: This is the largest cohort study using a 72-96 wire flow diverter. The Surpass Streamline demonstrated a favorable safety and efficacy profile, making it a valuable option for treating not only large but also wide-necked small and medium-sized intracranial aneurysms.

Keywords: Intracranial aneurysm; flow diverter; interventional; subarachnoid hemorrhage.

Figure 1.

(A1-5) Illustrative case 1: Flow diversion of a right ICA cavernous segment aneurysm with the SS. (A1) Preoperative 3-D reconstruction. (A2) SS delivery system: Infinity intermediate catheter (blue arrow), Cat 5 distal access catheter (yellow arrow), Streamline catheter containing the SS over synchro microwire 0.014 inch (green arrow). (A3) Full deployment of the SS. (A4) Optimal vessel wall apposition. (A5) DSA showing complete occlusion at 6 months. (B1-5) Illustrative case 2: Flow diversion with balloon-assisted angioplasty of a left ICA paraopthalmic saccular aneurysm. (B1) Preoperative 3-D reconstruction. (B2) Sub-optimal wall apposition in the midsegment (red arrow). (B3) Balloon-assisted angioplasty (green arrow). (B4) Post angioplasty image with showing improved FD aperture. (B5) DSA showing complete occlusion at 6 months.