E-232 Mid-term results of aneurysm treatment with the new surpass evolve flow diverter: a multicenter experience
Notice bibliographique
Résumé
Purpose Flow diverters have become a safe and well-accepted treatment option for intracranial aneurysms of most sizes in the anterior and posterior circulation. Surpass Evolve (SE, Stryker Neurovascular, Kalamazoo, Michigan, USA) is a new flow diverter that is available in large diameters (2.5–5 mm) and long lengths (12–40 mm), with high radial force and a high in-vitro flow diverting effect irrespective of the parent vessel tortuosity. This is secondary to a consistency in mesh density (15–30 pores/mm2) and a high number of wires (48–64, depending on the device length). SE can be deployed through an 0.027’ microcatheter, allowing easy navigation within tortuous anatomies. We describe device characteristics and mid-term results in the first patients treated with the SE for intracranial aneurysms. Materials and Methods We included in this report all patients that underwent aneurysm embolization with the SE at two different institutions. Patients’ data was prospectively collected in two databases and reviewed retrospectively. We included adult patients harboring non-ruptured saccular or fusiform intracranial aneurysms with a wide neck (>4 mm) located in the anterior or posterior circulation. Standard dual anti-platelet therapy was started 5 days pre-procedure and continued for at least 6 months. Neurological complications were classified as intra-procedural, early or delayed if they arose within 1, 30 or more than 30 days from treatment, respectively. Neurological complications were considered minor and major if resulting in transient or permanent neurological morbidity, respectively. Clinical status at discharge and follow up was assessed by independent neurologists or neurosurgeons and imaging included MRI angiography (MRA), CT angiography (CTA) and DSA, depending on the institution. Results The study included 28 patients (23 females, 82%; age range: 36–86, median age: 56) treated between April and November 2019, harboring 29 aneurysms. Twenty-eight aneurysms were saccular and in the anterior circulation. The majority of aneurysms were <12 mm in diameter (18/29, 62%), 8/29 (28%) were large (<25 mm), 2/29 (7%) were giant (>25 mm) and one was fusiform and partially thrombosed (3%). The SE was delivered in all cases via a tri-axial approach with an intermediate catheter and a 0.027’ microcatheter for implant delivery. This low-profile catheter allowed delivery of the implant through the trans-radial route. Thirty-two implants were used (4 in the patient with the fusiform aneurysm) with an average of 1.1 stents/patient. There were no intra-procedural complications. Median clinical and imaging follow up time was 6 months (range: 2–6 months). There were no deaths. Three patients (3/28, 11%) had early minor neurological complications. There was one (4%) early major neurological complication in a patient with a hemispheric stroke on post-op day 4. Two patients had minor delayed neurological complications (2/28, 7%). Complete thrombosis was seen in 16/29 aneurysms (55%, most of those imaged at 6 months), while partial thrombosis was seen in 12/29 aneurysms (41%). Covered side branches were patent in all patient but the one who experienced the stroke. Conclusion The SE shows excellent navigability while keeping a high flow-diverting effect. Mid-term clinico-radiological results show good efficacy and acceptable safety of the implant. Disclosures E. Orru: None. H. Rice: 2; C; Medtronic, Stryker, Philips, Penumbra, Microvention. L. De Villiers: None. A. Wakhloo: 1; C; Philips. 2; C; Stryker, Phenox. 3; C; SCENT trial. 4; C; InNeuroCo, EpiEP, Neural Analytics, Rist, Analytics 4 Life, ThrombX. G. Song Chia: None. A. Qureshi: None. T. Krings: 2; C; Stryker, Medtronic, Penumbra. 4; C; Marblehead Inc. V. Pereira: 1; C; Philips Healthcare. 2; C; Stryker, Balt, Cerenovous, Medtronic.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».