O-009 Flow diverter performance for the treatment of intracranial aneurysms: a multicenter comparative study

Introduction/Purpose Flow diverters (FD) have consolidated as a logical alternative for the treatment of intracranial aneurysms (IA). FD technology reduces operative time and length of in-hospital stay while maintaining high aneurysm obliteration and low complication rates. Supporting evidence, however, is limited to single-arm prospective studies that preclude direct device comparison. In this study, we aimed to compare the safety and efficacy of four FDs (Pipeline Embolization Device [PED], Surpass Streamline [SS], Flow Re-Direction Endoluminal Device [FRED], and Silk) in the treatment of IA. Materials and Methods We performed a multicenter retrospective cohort study in three countries (United States, Argentina, and Peru), including consecutive adult patients with IA treated with either PED, SS, FRED, or Silk between 2015 and 2021. Demographic, clinical, angiographic, and follow-up data were collected. The efficacy outcome was aneurysm occlusion measured by the Raymond Roy (RR) class, dichotomized into 1 vs. 2–3, on the last imaging follow-up. Safety outcomes included technical and neurologic ischemic/hemorrhagic complications at follow-up. Multivariable logistic regression was used to compare outcomes of interest. Results The analysis included 235 patients with 274 aneurysms; 102 patients were treated with PED, 58 with SS, 53 with FRED, and 40 with Silk. The median age was 57 years, and 202 (83%) were females. Asymptomatic cases for PED, SS, FRED, and Silk groups were 67%, 78%, 87%, and 88% (p<.001). The median baseline modified Rankin Scale score was 0. Most aneurysms were saccular (85%) located in the supraclinoid segment (75%). PED treated the biggest aneurysms (median dome diameter 6 mm), followed by Silk and SS (both in 4.6 mm)(p=.005). Six cases had > 1 device implanted. Technical complication rates, including incomplete wall apposition and fish mouthing, were not different between groups (8%, 14%, 2%, and 8% in PED, SS, FRED, and Silk groups, respectively)(p=.30). After adjusting for confounders, there was no statistical difference (p=.32). Mean final follow-up was 12 months, complete occlusion rate was: 70%, 64%, 68%, and 74% in the PED, SS, FRED, and Silk groups, respectively (p=.2). After adjusting for confounders, odds ratios for occlusion were not different (p=.56). The rate of neurologic complications was: 4%, 12%, 0%, and 10% in the PED, SS, FRED, and Silk groups, respectively (p=.016). After adjusting for confounders, neurologic complications were associated with baseline mRS (p=.012), adjunctive device use (p=.007), and parent vessel stenosis(p=.001). Conclusion Our data suggest a comparable performance between different FD in a heterogeneous patient population. Differences in device characteristics may dictate subtle technical and safety nuances that can be considered to individualize and optimize IA treatments. Disclosures J. Vivanco-Suarez: None. J. Basilio Flores: None. J. Miranda: None. G. Foa-Torres: None. D. Altschul: None. A. Dajles: None. C. Zevallos: None. M. Galecio-Castillo: None. M. Farooqui: None. J. Aguilar-Melgar: None. H. Pacheco-Fernandez Baca: None. S. Ortega-Gutierrez: 2; C; Medtronic, Stryker.