Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Kentucky Neuroscience Institute, University of Kentucky, Lexington, Kentucky, USA.
World Neurosurg. 2022 Jun;162:e281-e287. doi: 10.1016/j.wneu.2022.03.008. Epub 2022 Mar 8.
Flow diversion has revolutionized endovascular treatment for cerebral aneurysms. The Surpass Streamline flow diverter (SSFD) has shown promise for expanding flow diversion device options for aneurysm treatment. SSFD differs from earlier stents by maintaining high porosity with increased pore density to ensure appropriate flow disruption. Given the delivery system's increased dimension options and potential greater flow-diverting properties, SSFD is poised to extend the anatomic and pathologic reaches of flow diversion therapy.
Data pertaining to SSFD-treated aneurysms were gathered retrospectively between 2019 and 2020, including aneurysm location, size, symptoms, complications, and occlusions rates at follow-up. Size was categorized as small (<10 mm), large (10-25 mm), and giant (>25 mm) according to SCENT (Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide Neck Aneurysms) criteria. Aneurysm occlusion on follow-up imaging was characterized by Simple Measurement of Aneurysm Residual after Treatment (SMART) grading with adequate occlusion defined as grades 3 and 4. Imaging was performed at time of treatment and 6-month and 1-year follow-up.
There were 42 aneurysms treated with SSFD throughout the cerebrovascular system: 3 cervical, 4 posterior, and 35 intracranial anterior circulation. Complete occlusion rates at 6 months and 1 year were 48% and 57% with adequate occlusion achieved in 89.6% and 85.7%, respectively. Rates of complete occlusion were higher for small (69%) compared with large (38%) aneurysms.
Our data suggest comparable complete occlusion rates compared with SCENT (66.1% vs. 57% in our center) and adequate occlusion rates. Similar occlusion rates to prior studies despite broadened inclusion criteria and diversity of treated aneurysms demonstrate favorable generalizability of flow-diverting technology to a wide array of aneurysmal pathology.
血流导向装置的出现彻底改变了颅内动脉瘤的血管内治疗。Surpass Streamline 血流导向装置（SSFD）为动脉瘤治疗提供了更多的血流导向装置选择，具有广阔的应用前景。SSFD 与早期支架的不同之处在于，它通过增加孔径密度来保持高孔隙率，以确保适当的血流中断。鉴于输送系统的尺寸选择增加和潜在的更大的血流导向特性，SSFD 有望扩展血流导向治疗的解剖和病理范围。
回顾性收集了 2019 年至 2020 年期间接受 SSFD 治疗的动脉瘤患者的数据，包括动脉瘤的位置、大小、症状、并发症和随访时的闭塞率。根据 SCENT（Surpass 颅内动脉瘤栓塞系统治疗大或巨大宽颈动脉瘤的关键试验）标准，大小分为小（<10mm）、大（10-25mm）和巨大（>25mm）。随访时的动脉瘤闭塞情况采用 SMART 分级进行评估，完全闭塞定义为分级 3 和 4。治疗时和治疗后 6 个月和 1 年进行影像学检查。
SSFD 治疗了 42 个颅内动脉系统的动脉瘤：3 个颈内动脉、4 个后循环和 35 个前循环颅内动脉瘤。6 个月和 1 年的完全闭塞率分别为 48%和 57%，其中 89.6%和 85.7%达到了足够的闭塞程度。小动脉瘤（69%）的完全闭塞率高于大动脉瘤（38%）。
与 SCENT 相比（我们中心的完全闭塞率分别为 66.1%和 57%），我们的数据表明该装置的完全闭塞率和足够闭塞率相当。尽管纳入标准放宽，治疗的动脉瘤类型多样化，但与既往研究相似的闭塞率表明血流导向技术具有广泛的适用性，可以应用于广泛的动脉瘤病变。
