Intraprocedural Technical Events During Flow Diverter Implantation Partially Mediate the Effect of Age on Aneurysm Occlusion
Year: 2025
Type: article
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, P <0.001) and a higher incidence of intraprocedural technical events (adjusted odds ratio = 1.088, P <0.001). Intraprocedural technical events were inversely associated with occlusion (adjusted odds ratio = 0.265, P = 0.004), and mediation analysis revealed that 16.3% of the effect of age on aneurysm occlusion was mediated by these events. 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.
Authors: Juan Vivanco‐Suarez, Aaron Rodriguez‐Calienes, Yujing Lu, Ricardo Hanel, Justin A. Singer, Kimon Bekelis, Kainaat Javed, David J. Altschul, Johanna T. Fifi, Stavros Matsoukas, Philip M. Meyers, Jared Cooper, Fawaz Al‐Mufti, Bradley Gross, Brian Jankowitz, Peter T. Kan, Muhammad Hafeez, Emanuele Orru, Marco Malaga, Milagros Galecio‐Castillo, Alexander L. Coon, Ajay K. Wakhloo, Santiago Ortega‐Gutierrez
Institutions: University of Iowa Hospitals and Clinics, University of Miami, Jackson Memorial Hospital, Baptist Medical Center Jacksonville, Spectrum Health, Corewell Health Blodgett Hospital, Good Samaritan University Hospital, Montefiore Medical Center, Mount Sinai Hospital, Columbia University Irving Medical Center, Columbia University, Westchester Medical Center, New York Medical College, University of Pittsburgh Medical Center, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, The University of Texas Medical Branch at Galveston, Lahey Hospital and Medical Center, Lahey Medical Center, Carondelet Health Network
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,300
OpenAlex ID: W4412043312