Flow Diversion for Intracranial Aneurysms in Large-Diameter Vessels: A Subanalysis From the SESSIA Study

BACKGROUND: Flow diverters are now considered first-line tools for treating intracranial aneurysms. However, few devices are available for patients with large-diameter vessels (LDVs). Hence, we evaluated the performance of the largest diameter Surpass Streamline for aneurysms in LDVs. METHODS: We performed a subanalysis of the SESSIA (Safety and Efficacy of the Surpass Streamline for Intracranial Aneurysms) multicenter cohort study of patients treated with Surpass Streamline between 2018 and 2021. Patients in whom a 5mm diameter Surpass Streamline was implanted were divided into 2 groups according to vessel diameter at the landing zones (LDV, >= 5.3 mm versus non-LDV [N-LDV], <5.3 mm). Efficacy was complete occlusion at final follow-up. Safety was ischemic/hemorrhagic events and mortality up to 30 days. RESULTS: Thirty patients harboring 30 aneurysms were included. Fifteen cases were included per group (LDV versus N-LDV). Baseline demographics, clinical characteristics, median aneurysm size (LDV, 11 mm versus N-LDV, 10 mm), and location were similar. Vessel diameters at the proximal (LDV, 5.3 mm versus N-LDV, 4.2 mm; P<0.001) and distal (5.6 versus 4.0 mm; P<0.001) flow diverter landing zones were different. Procedural characteristics (including balloon-assisted angioplasty and stenting) were similar. At the final follow-up (12 +/- 6 months), complete occlusion (LDV, 75% versus N-LDV, 84%; P=0.548), and ischemic/hemorrhagic events (1 per group; P=1.00) were not different. CONCLUSIONS: The use of large-diameter flow diverters for treating complex intracranial aneurysms arising in LDVs is technically feasible and safe. Comparative studies evaluating devices suitable for this patient population will provide valuable insights for the best device selection.