E-169 Surface modified flow-diverters for intracranial aneurysms: a systematic review and meta-analysis. (23rd July 2022)

• Record Type: Journal Article
• Authors: Monteiro, A; Ciecierska, S; Khan, S; Khawar, W; Khan, A; Donnelly, B; Waqas, M; Cappuzzo, J; Fayyaz, N; Siddiqui, A; Levy, E
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A167
• Page End: A168
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.280
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Despite its high efficacy, flow-diverters (FD) still have limitations with regards to thromboembolic risk (6%) due to the high metal content, and bleeding events (27%) related to the dual-antiplatelet regimen (DAPT) required. The next frontier of flow-diversion relies on surface modification of devices to reduce their thrombogenicity. In the current study, we performed a systematic review and meta-analysis of surface modified FDs in the treatment of intracranial aneurysms, aiming to evaluate their angiographic outcomes, complications and clinical outcomes based on the available literature. Methods: We performed comprehensive systematic searches of PubMed, EMBASE and MEDLINE databases, using keywords with Boolean operators ('pipeline shield'; 'PED Shield'; 'shield technology'; 'surface modification'; 'derive embolization device'; 'p48'; 'p64'; 'intracranial aneurysm'). We included articles reporting treatment of intracranial aneurysms with surface modified FDs. Demographics, aneurysms characteristics, complications, clinical and angiographic outcomes were extracted for calculation of estimated weighted rates and respective 95% confidence intervals (CI). Results: Seventeen articles were included, comprising 1013 patients with 1112 aneurysms. Overall, 76.6% (95% CI 71.7%-82.1%) of patients were females, 85.6% (95% CI 80.2%-91.1%) of aneurysms were located in the anterior circulation and 10.2% (95% CI 5.4%-15%) were ruptured. Use of adjunctive coiling across the studies was 21.2% (95% CI 14.9%-27.5%). Rates of intraoperative and post-operative complications was 2.3% (95% 1.3%-3.3%) and 3.4% (95% CI 2.2%-4.6%), respectively. Rate of complete occlusion was 73.8% (95% CI 65.4%-82.2%). Mortality rate was 1.5% (95% CI 0.5%-2.5%). Conclusion: Surface modified FDs had overall high rates of complete occlusion and low rates of complications and mortality in our meta-analysis. Direct comparison with non-surface modified devices are needed. Disclosures: A. Monteiro: None. S. Ciecierska: None. S. Khan: None. W. Khawar: None. A. Khan: None. B. Donnelly: None. M. Waqas: None. J. Cappuzzo: None. N. Fayyaz: None. A. Siddiqui: 2; C; Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc., . 4; C; Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical, . E. Levy: 2; C; Claret Medical, GLG Consulting, Guidepoint Global, Imperial Care, Medtronic, Rebound, StimMed, Misionix, Mosiac, Clarion, IRRAS. 4; C; NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical.