DWI-based comparison of thrombogenicity between Surpass Evolve and Surpass Elite flow diverters: an IPTW-adjusted study

BACKGROUND AND PURPOSE: Surpass Elite (SEl) incorporates optimized device geometry and a surface modification strategy called surface neutralization. We conducted a retrospective cohort comparison of SEl-FDs and Surpass Evolve (SEv)-FDs to compare the incidence and burden of early postprocedural DWI-positive lesions as surrogate markers of thromboembolic injury. MATERIALS AND METHODS: This study included patients treated with SEl-FDs or SEv-FDs at two tertiary hospitals between November 2019 and February 2026. We examined the rates of patient with DWI-positive lesions and the number of lesions between the two groups using inverse probability of treatment weighting (IPTW) analysis. Furthermore, we performed logistic regression for risk factor analysis. RESULTS: Of 149 patients, 101 were treated with SEv-FDs and 48 with SEl-FDs. After IPTW adjustment, an adequate balance was observed for all covariates. When comparing the two groups, the incidence of DWI-positive lesions differed between SEv-FD and SEl-FD (SEv-FD, 64.1% vs SEl-FD, 44.2%); the odds of DWI-positivity were 56% lower in the SEI FD group, and the difference was statistically significant (odds ratio [OR]: 0.44; 95% confidence interval [CI]: 0.20–0.99, P = 0.048). The mean number of lesions was lower in SEl-FD than in SEv-FD group (SEv-FD, 8.69 vs SEl-FD, 6.02), but the difference did not reach statistical significance (incidence rate ratio [IRR]: 0.69, 95% CI: 0.45–1.06, P = 0.091). In multivariable logistic regression, the device was the only significant risk factor for DWI-positive lesions(OR: 0.41, 95% CI: 0.19–0.87, P = 0.02). CONCLUSIONS: SEl-FDs showed a significantly lower incidence of DWI-positive lesions and a lower number of lesions. This suggests that thromboresistance was improved in SEl-FD compared with SEv-FD.