Efficacy and Safety of Surpass Evolve Flow Diverter for Intracranial Aneurysms

Introduction/Purpose Flow diversion is an established endovascular technique for the treatment of intracranial aneurysms. This study aimed to evaluate the safety and efficacy of the Surpass Evolve flow diverter (SE‐FD) in the treatment of unruptured intracranial aneurysms. Materials/Methods Between April 2022 and April 2025, we prospectively enrolled patients with unruptured intracranial aneurysms treated with SE‐FD at our center. All patients underwent pre‐procedural dual antiplatelet therapy with prasugrel (10 mg) and aspirin (100 mg) for five days before intervention. Primary outcomes included aneurysm occlusion, ischemic and hemorrhagic complications, and 6‐month mortality. Occlusion was assessed at 3 months with contrast‐enhanced magnetic resonance angiography (MRA) and at 6 months using the O’Kelly‐Marotta (OKM) grading scale on digital subtraction angiography (DSA). Results Seventy‐eight patients with 89 aneurysms were treated with SE‐FD. The mean aneurysm width was 6.8 mm, height 5.9 mm, and neck size 4.2 mm. Headache was the presenting symptom in 30% of patients, and 20% had a family history of aneurysms. Ten aneurysms were located outside the internal carotid artery. No intraoperative complications occurred. Two patients (2.5%) developed in‐stent thrombosis, both managed with intra‐arterial tirofiban; one patient achieved complete recovery (mRS 0), while the other had residual deficits (mRS 4) with bilateral amaurosis and cautious gait. No treatment‐related deaths were observed. At 6 months, angiographic follow‐up demonstrated complete occlusion (OKM grade D) in 33 patients (42.3%), near‐complete occlusion (grade C) in 9 patients, and partial occlusion (grade B) in 5 patients. The maximum occlusion rate at 312 days was 66%. Conclusion The Surpass Evolve flow diverter demonstrated high efficacy and an acceptable safety profile in the treatment of unruptured intracranial aneurysms, supporting its role as a reliable device in contemporary endovascular practice.