High mesh density flow diversion of upper basilar artery aneurysms: Experience in 23 cases

BackgroundFlow diversion has proven feasible for treating posterior circulation aneurysms. These studies, however, are limited to the utilization of low-mesh density devices. The high-mesh density and mesh geometry of the Surpass Evolve and Streamline flow diverters theoretically allow increased flow diversion while preserving perforators, a critical consideration in posterior circulation flow diversion. We investigate this phenomenon in the largest known series utilizing solely high-mesh density devices for basilar aneurysms.MethodsA prospectively maintained, IRB-approved database of the senior authors was retrospectively reviewed for flow diversion cases involving the upper basilar artery and utilizing Surpass Evolve or Streamline. Technical success was defined as the successful implantation of the device without intraprocedural device removal.ResultsOver a 52-month study period, 23 cases were identified utilizing Surpass Evolve (21 devices) and Surpass Streamline (2 devices) treating aneurysms located along the basilar apex (12 cases, 52%) and superior cerebellar artery (11 cases, 48%). Technical success was achieved in all cases (23 cases, 100%). Patients were placed on antiplatelet therapy consisting of aspirin (22 cases, 95.7%) and ticagrelor (20 cases, 87%) or prasugrel (4 cases, 17.4%). There was one mortality within the 30-day postoperative window due to complications of the presenting high-grade SAH.ConclusionThe treatment of upper basilar and basilar apex aneurysms with high mesh density devices can be performed with acceptable safety standards. Further studies are needed to confirm the safety profile, occlusion rates, and applicability of these findings to lower mesh-density 48-wire flow-diverter implants at the basilar apex.