Journal article
Intraprocedural Technical Events During Flow Diverter Implantation Partially Mediate the Effect of Age on Aneurysm Occlusion
Stroke: vascular and interventional neurology, Vol.5(5), e001730
09/2025
DOI: 10.1161/SVIN.125.001730
PMCID: PMC12697608
PMID: 41573326
Appears in UI Libraries Support Open Access
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.
Details
- Title: Subtitle
- Intraprocedural Technical Events During Flow Diverter Implantation Partially Mediate the Effect of Age on Aneurysm Occlusion
- Creators
- Juan Vivanco-Suarez - University of IowaAaron Rodriguez-Calienes - Jackson Memorial HospitalYujing LuRicardo Hanel - Baptist Medical Center JacksonvilleJustin A. Singer - Corewell Health Blodgett HospitalKimon Bekelis - Good Samaritan University HospitalKainaat Javed - Montefiore Medical CenterDavid J. Altschul - Montefiore Medical CenterJohanna T. Fifi - Mount Saint Vincent UniversityStavros Matsoukas - Mount Saint Vincent UniversityPhilip M. MeyersJared Cooper - Westchester Medical CenterFawaz Al-Mufti - Westchester Medical CenterBradley Gross - University of Pittsburgh Medical CenterBrian Jankowitz - Hospital of the University of PennsylvaniaPeter T. Kan - The University of Texas Medical Branch at GalvestonMuhammad Hafeez - The University of Texas Medical Branch at GalvestonEmanuele Orru - Lahey Medical CenterMarco Malaga - University of IowaMilagros Galecio-Castillo - University of IowaAlexander L. Coon - Saint Joseph's HospitalAjay K. Wakhloo - Lahey Medical CenterSantiago Ortega-Gutierrez - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Stroke: vascular and interventional neurology, Vol.5(5), e001730
- DOI
- 10.1161/SVIN.125.001730
- PMID
- 41573326
- PMCID
- PMC12697608
- NLM abbreviation
- Stroke Vasc Interv Neurol
- ISSN
- 2694-5746
- eISSN
- 2694-5746
- Publisher
- Wiley
- Grant note
- Stryker: 2021-HEM-034
Stryker funded this study through an investigator-initiated grant (Grant/Award Number: 2021-HEM-034).
- Language
- English
- Electronic publication date
- 07/04/2025
- Date published
- 09/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984845457002771
Metrics
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