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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. [ABSTRACT FROM AUTHOR]

Aneurysm boundary has been marked with a dashed line for visibility. c Contrast-enhanced CBCT MIP coronal reconstruction from right vertebral artery injection immediately after flow diversion construct placement. A contrast-enhanced CBCT showed extensive acute thrombosis of the aneurysm with preserved patency of the stent construct and of the origins of several pontine arteries seen previously (Fig. Introduction Successful flow diversion, with progressive aneurysm thrombosis while maintaining side branch patency, requires complete apposition of the implant to healthy vessel segments proximal and distal to an aneurysm [[1]]. [Extracted from the article]

Background Existing travel restrictions limit the mobility of proctors, significantly delaying clinical trials and the introduction of new neurointerventional devices. We aim to describe in detail technical and legal considerations regarding international teleproctoring, a tool that could waive the need for in-person supervision during procedures. Methods International teleproctoring was chosen to provide remote supervision during the first three intracranial aneurysm treatments with a new flow diverter (currently subject of a clinical trial) in the US. Real-time, high-resolution transmission software streamed audiovisual data to a proctor located in Canada. The software allowed the transmission of images in a de-identified, HIPAA-compliant manner. Results All three flow diverters were implanted as desired by operator and proctor and without complication. The proctor could swap between images from multiple sources and reported complete spatial and situational awareness, without any significant lag or delay in communication. Procedural times and radiologic dose were similar to those of uncomplicated, routine flow diversion cases at our institution. Conclusions International teleproctoring was successfully implemented in our clinical practice. Its first use provided important insights for establishing this tool in our field. With no clear horizon for lifting the current travel restrictions, teleproctoring has the potential to remove the need for proctor presence in the angiography suite, thereby allowing the field to advance through the continuation of trials and the introduction of new devices in clinical practice. In order for this tool to be used safely and effectively, highly reliable connection and highresolution equipment is necessary, and multiple legal nuances have to be considered. [ABSTRACT FROM AUTHOR]

Background Flow diverting stent (FDS) devices have revolutionized the treatment of large and complex brain aneurysms, but there is still room for improvement, particularly on the flow diversion properties and technical challenges associated with stent deployment. In this study we compared flow diversion properties between the new generation Surpass Evolve (Stryker) and the Pipeline Flex (Medtronic) devices by quantitatively evaluating intra-aneurysmal flow modification. Methods An in vitro experimental set-up was used, consisting of four patient-specific silicone models with internal carotid aneurysms and a circulating hemodynamic simulation system with pulsatile flow. The Evolve and Pipeline stents were deployed across the neck of each aneurysm model, in a randomized fashion, for a total of eight device deployments. A 60 frames/s digital subtraction angiography run was acquired before and after placement of each FDS. An optical flow-analysis method was used to measure intra-aneurysmal flow modification induced by the stent by calculating a mean aneurysm flow amplitude (MAFA) before and after stent placement and computing a ratio. Results Average MAFA ratio values calculated from pre- and post-stent placement were significantly lower after deployment of the Evolve (n=4, mean=0.62±0.09) compared with the Pipeline device (n=4, mean=0.71±0.06) (p=0.03). Conclusions Our in vitro results show that the Evolve stent had a superior flow diversion effect compared with the Pipeline stent, which--based on clinical evidence--suggest it may promote faster aneurysm occlusion rates in patients. [ABSTRACT FROM AUTHOR]

Endovascular thrombectomy revolutionized the treatment of acute ischemic stroke. Nevertheless, access to endovascular thrombectomy is limited in many parts of the world. Asia holds 60% of the world's population and its countries carry some of the highest stroke disease burden. To understand the availability of endovascular thrombectomy and intravenous thrombolysis in this region, we interviewed stroke neurologists and neuro-interventionists of 19 Asian countries, and found a large disparity in access to endovascular thrombectomy and intravenous thrombolysis between high- and low-income countries. Lack of neuro-interventionists, comprehensive stroke units, stroke triage systems and high treatment cost are the major obstacles to wider accessibility of endovascular thrombectomy, especially among developing countries. The potential solutions to provide equitable access to stroke revascularization therapy are discussed. [ABSTRACT FROM AUTHOR]

Background Femoral access is the traditional approach for endovascular carotid artery stenting. Radial access is increasingly used as an alternative approach due to its known anatomical advantages in patients with unfavorable aortic arch morphology via the femoral approach and its excellent access site safety profile. Our objective was to analyze procedural success using radial access for carotid artery stenting as reported in the literature. Methods Three online databases were systematically searched following PRISMA guidelines for studies (n ≥ 20) using radial artery access for carotid artery stenting (1999-2018). Random-effects meta-analysis was used to pool the procedural success (successful stent placement with no requirement for crossover to femoral access), mortality, and complication rates associated with radial access. Results Seven eligible studies reported procedural success outcomes with a pooled meta-analysis rate of 90.8% (657/723; 95% CI 86.7% to 94.2%; I²=53.1%). Asymptomatic radial artery occlusion occurred in 5.9% (95% CI 4.1% to 8.0%; I²=0%) and forearm hematoma in 1.4% (95% CI 0.4% to 2.9%; I²=0%). Risk of minor stroke/transient ischemic attack was 1.9% (95% CI 0.6% to 3.8%; I²=42.3%) and major stroke was 1.0% (95% CI 0.4% to 1.8%; I²=0%). There were three deaths across the seven studies (0.6%; 95% CI 0.2% to 1.3%; I²=0%). The meta-analysis was limited by statistically significant heterogeneity for the primary outcome of procedural success. Conclusion Radial access for carotid artery stenting has a high procedural success rate with low rates of mortality, access site complications, and cerebrovascular complications. The potential benefits of this approach in patients with unfavorable aortic arch access should be explored in a prospective randomized trial. [ABSTRACT FROM AUTHOR]