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

Adam A Dmytriw; Hamza Adel Salim; Basel Musmar; Nicole M Cancelliere; Christoph J Griessenauer; Robert W Regenhardt; Jesse Jones; Vincent Tutino; Zuha Hasan; Nicola Limbucci; Sovann V Lay; Julian Spears; James D Rabinov; Mark R Harrigan; Adnan H Siddiqui; Elad I Levy; Christopher J Stapleton; Leonardo Renieri; Christophe Cognard; Hamza Shaikh; Anna Luisa Kühn; Markus A Möhlenbruch; Stavropoula I Tjoumakaris; Pascal Jabbour; Philipp Taussky; Fabio Settecase; Manraj K S Heran; Anh Nguyen; David Volders; Pablo Harker; Diego A Devia; Ajit S Puri; Marios Psychogios; Juan C Puentes; Giuseppe Leone; Giuseppe Buono; Margherita Tarantino; Mario Muto; Francesco Briganti; Shamsher Dalal; Vamsi Gontu; Rodolfo E Alcedo Guardia; Juan C Vicenty-Padilla; Patrick Brouwer; Matthias H Schmidt; Clemens Schirmer; Gwynedd E Pickett; Tommy Andersson; Michael Söderman; Thomas R Marotta; Hugo Cuellar-Saenz; Ajith J Thomas; Aman B Patel; Vitor Mendes Pereira; Nimer Adeeb; Flow diversion Multinational Observational cohort Device comparsion (FlowMOD) Investigators

doi:10.1007/s00062-024-01435-x

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

Clin Neuroradiol. 2024 Jul 18. doi: 10.1007/s00062-024-01435-x. Online ahead of print.

Authors

Adam A Dmytriw^{1

2

3

4

5}, Hamza Adel Salim^{6

7

7}, Basel Musmar⁸, Nicole M Cancelliere⁹, Christoph J Griessenauer¹⁰, Robert W Regenhardt¹¹, Jesse Jones¹², Vincent Tutino¹³, Zuha Hasan¹⁴, Nicola Limbucci¹⁵, Sovann V Lay¹⁶, Julian Spears¹⁴, James D Rabinov¹¹, Mark R Harrigan¹⁴, Adnan H Siddiqui¹³, Elad I Levy¹³, Christopher J Stapleton¹¹, Leonardo Renieri¹⁷, Christophe Cognard¹⁸, Hamza Shaikh¹⁹, Anna Luisa Kühn²⁰, Markus A Möhlenbruch²¹, Stavropoula I Tjoumakaris²², Pascal Jabbour²³, Philipp Taussky²⁴, Fabio Settecase²⁵, Manraj K S Heran²⁵, Anh Nguyen²⁶, David Volders²⁷, Pablo Harker²⁸, Diego A Devia²⁹, Ajit S Puri³⁰, Marios Psychogios²⁶, Juan C Puentes²⁹, Giuseppe Leone^{31

32}, Giuseppe Buono³², Margherita Tarantino³², Mario Muto³¹, Francesco Briganti³¹, Shamsher Dalal³³, Vamsi Gontu³⁴, Rodolfo E Alcedo Guardia³⁵, Juan C Vicenty-Padilla³⁵, Patrick Brouwer³⁴, Matthias H Schmidt²⁷, Clemens Schirmer³³, Gwynedd E Pickett²⁷, Tommy Andersson³⁴, Michael Söderman³⁴, Thomas R Marotta²³, Hugo Cuellar-Saenz⁸, Ajith J Thomas³⁶, Aman B Patel¹¹, Vitor Mendes Pereira¹¹, Nimer Adeeb⁸; Flow diversion Multinational Observational cohort Device comparsion (FlowMOD) Investigators

Affiliations

¹ Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada. [email protected].
² Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA. [email protected].
³ Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. [email protected].
⁴ Neuroendovascular Program, Massachusetts General Hospital: Brigham, Boston, USA. [email protected].
⁵ Women's Hospital, Harvard University, Boston, MA, USA. [email protected].
⁶ Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA. [email protected].
⁷ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA. [email protected].
⁸ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA.
⁹ Department of Neuroradiology, St. Michael's Hospital, Toronto, ON, Canada.
¹⁰ Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Salzburg, Austria.
¹¹ Department of Neuroradiology, Massachusetts General Hospital & Brigham and Women's Hospital, Boston, MA, USA.
¹² Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
¹³ Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁴ Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
¹⁵ Department of Neurosurgery and Neuroradiology, New York Presbyterian Hospital and Weill Cornell School of Medicine, New York, NY, USA.
¹⁶ Department of Neuroradiology, Centre Hospitalier de Toulouse, Toulouse, France.
¹⁷ Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
¹⁸ Department of Diagnostic and Therapeutic Neuroradiology, Toulouse University Hospital, Toulouse, France.
¹⁹ Department of Neuroradiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia.
²⁰ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
²¹ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
²² Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
²³ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
²⁴ Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
²⁵ Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
²⁶ Department of Neuroradiology, University Hospital of Basel, Basel, Switzerland.
²⁷ Divisions of Neuroradiology & Neurosurgery, QEII Health Sciences Centre, Dalhousie Medical School, Halifax, NS, USA.
²⁸ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
²⁹ Hospital Universitario San Ignacio, Pontificia Universidad Javeriana School of Medicine Bogotá, Bogotá, Colombia.
³⁰ Department of Neuroradiology, UMass Memorial Hospital, Worcester, MA, USA.
³¹ Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples, Italy.
³² Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
³³ Departments of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA.
³⁴ Departments of Neuroradiology and Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
³⁵ Department of Neurosurgery, University of Puerto Rico, School of Medicine, San Juan, PR, USA.
³⁶ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.

PMID: 39023541
DOI: 10.1007/s00062-024-01435-x

Abstract

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.

Keywords: Flow Diverter Devices; Hemorrhagic Complications; Intracranial Aneurysms; Modified Rankin Scale; Pipeline Emboliza on Device; Thromboembolic Complications.