Intraprocedural Technical Events During Flow Diverter Implantation Partially Mediate the Effect of Age on Aneurysm Occlusion.

Document Type

Article

Publication Date

9-1-2025

Publication Title

Stroke: Vascular and Interventional Neurology

Abstract

BACKGROUND: Flow diverters (FDs) are the first line of treatment for specific intracranial aneurysms. However, aneurysm persistence at follow-up presents in up to 25%. Occlusion after flow diversion in older patients seems less effective due to clinical, anatomical, and physiological characteristics. We aimed to study the effect of age on aneurysm occlusion mediated by intraprocedural technical events.

METHODS: We conducted a pooled analysis of 2 cohorts, including patients with unruptured saccular aneurysms in the internal carotid artery, treated with the Surpass Streamline FD. Multivariable logistic regression was used to identify predictors of complete occlusion at 12-month follow-up. A mediation analysis was performed to assess the role of intraprocedural technical events (eg, fish-mouthing of the distal end, poor device opening, FD twisting, foreshortening, excess friction of the FD and the delivery system during deployment, and delivery system kink) in the relationship between age and occlusion rates.

RESULTS: A total of 316 patients (mean age 59.4 ± 11.2 years) were included. Complete aneurysm occlusion was achieved in 82% of cases at 12 months. Increasing age was associated with lower odds of occlusion (adjusted odds ratio = 0.962,

CONCLUSION: Intraprocedural technical events partially mediate the effect of age on complete aneurysm occlusion after FD treatment. Identifying additional mechanisms that influence occlusion could improve procedural outcomes, particularly in older patients.

Volume

5

Issue

5

First Page

e001730

Last Page

e001730

DOI

10.1161/svin.125.001730

ISSN

2694-5746

PubMed ID

41573326

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