Comparative Efficacy of Flow Diverter Devices in the Treatment of Carotid Sidewall Intracranial Aneurysms: a Retrospective, Multicenter Study.

Background: The comparative efficacy and safety of first-generation flow diverters (FDs), Pipeline Embolization Device (PED) (Medtronic, Irvine, California), Silk (Balt Extrusion, Montmorency, France), Flow Re-direction Endoluminal Device (FRED) (Microvention, Tustin, California), and Surpass Streamline (Stryker Neurovascular, Fremont, California), is not directly established and largely inferred.
Purpose: This study aimed to compare the efficacy of different FDs in treating sidewall ICA intracranial aneurysms.
Methods: We conducted a retrospective review of prospectively maintained databases from eighteen academic institutions from 2009-2016, comprising 444 patients treated with one of four devices for sidewall ICA aneurysms. Data on demographics, aneurysm characteristics, treatment outcomes, and complications were analyzed. Angiographic and clinical outcomes were assessed using various imaging modalities and modified Rankin Scale (mRS). Propensity score weighting was employed to balance confounding variables. The data analysis used Kaplan-Meier curves, logistic regression, and Cox proportional-hazards regression.
Results: While there were no significant differences in retreatment rates, functional outcomes (mRS 0-1), and thromboembolic complications between the four devices, the probability of achieving adequate occlusion at the last follow-up was highest in Surpass device (HR: 4.59; CI: 2.75-7.66, p < 0.001), followed by FRED (HR: 2.23; CI: 1.44-3.46, p < 0.001), PED (HR: 1.72; CI: 1.10-2.70, p = 0.018), and Silk (HR: 1.0 ref. standard). The only hemorrhagic complications were with Surpass (1%).
Conclusion: All the first-generation devices achieved good clinical outcomes and retreatment rates in treating ICA sidewall aneurysms. Prospective studies are needed to explore the nuanced differences between these devices in the long term.
Competing Interests: Declarations Conflict of interest A.A. Dmytriw, H.A. Salim, B. Musmar, N.M. Cancelliere, J. Jones, V. Tutino, Z. Hasan, N. Limbucci, S.V. Lay, J. Spears, J.D. Rabinov, M.R. Harrigan, A.H. Siddiqui, E.I. Levy, C.J. Stapleton, L. Renieri, C. Cognard, H. Shaikh, A.L. Kühn, M.A. Möhlenbruch, P. Taussky, F. Settecase, M.K.S. Heran, A. Nguyen, D. Volders, P. Harker, D.A. Devia, M. Psychogios, J.C. Puentes, G. Leone, G. Buono, M. Tarantino, M. Muto, F. Briganti, S. Dalal, V. Gontu, R.E. Alcedo Guardia, J.C. Vicenty-Padilla, P. Brouwer, M.H. Schmidt, C. Schirmer, G.E. Pickett, T. Andersson, M. Söderman, T.R. Marotta, H. Cuellar-Saenz, A.J. Thomas, A.B. Patel, V. Mendes Pereira and N. Adeeb. R.W. Regenhardt serves on a DSMB for a trial sponsored by Rapid Medical, serves as site PI for studies sponsored by Penumbra and Microvention, and receives stroke research grant funding from the National Institutes of Health, Society of Vascular and Interventional Neurology, and Heitman Stroke Foundation. Dr. Guenego reports consultancy for Rapid Medical and Phenox, not directly related to the present work. C.J. Griessenauer reports a proctoring agreement with Medtronic and research funding by Penumbra. A.S. Puri is a consultant for Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical, he received research grants from NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular, and holds stocks in InNeuroCo, Agile, Perfuze, Galaxy and NTI. S.I. Tjoumakaris is a consultant for Medtronic and Microvention (funds paid to institution, not personally). P. Jabbour is a consultant for Medtronic, Microvention and Cerus. Dr. Clarençon reports conflicts of interest with Medtronic, Balt Extrusion (consultant), ClinSearch (core lab), Penumbra, Stryker (payment for reading) and Artedrone (Board); all not directly related to the present work. Dr. Henninger received support from W81XWH-19-PRARP-RPA form the CDMRP/DoD, NS131756 and U24NS113844 from the NINDS, and NR020231 from the NINR and received compensation from Myrobalan, Inc. and General Dynamics during the conduct of this study unrelated to this work. Dr. Liebeskind is consultant as Imaging Core Lab to Cerenovus, Genentech, Medtronic, Stryker, Rapid Medical. Dr. Yeo reports Advisory work for AstraZeneca, Substantial support from NMRC Singapore and is a medical advisor for See-mode, Cortiro and Sunbird Bio, with equity in Ceroflo. All unrelated to the present work. Dr. Marnat reports conflicts of interest with Microvention Europe, Stryker Neurovascular, Balt (consulting), Medtronic, Johnson & Johnson and Phenox (paid lectures), all not directly related to the present work. Ethical standards The study received approval from the local ethical standards committee at each participating site, and informed consent from patients was waived. The data supporting this study’s findings are available from the corresponding author upon reasonable request.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)