{
  "abstract": "Background The Surpass Elite (Stryker Neurovascular) is a third-generation flow diverter featuring an increased braid angle (>150°) and novel BioStealth surface charge neutralization designed to reduce thrombogenicity. Its predecessor, the Surpass Evolve, required adjunctive balloon angioplasty in 26.1% of cases; the Elite’s steeper braid angle was engineered to improve spontaneous device opening. Despite FDA clearance in June 2024, no peer-reviewed clinical outcome data exist. We report the first clinical experience with the Surpass Elite globally.Methods We conducted a retrospective analysis of 81 consecutive aneurysms in 78 patients treated with the Surpass Elite across four centers by two experienced neurointerventionalists, January to July 2025. No exclusion criteria were applied to capture real-world practice. Endpoints included technical success, perioperative complications, and angiographic and clinical outcomes at approximately 6-month follow-up. Occlusion was graded using the Raymond-Roy (RROC) and O’Kelly-Marotta (OKM) scales. Functional outcome was assessed by the modified Rankin Scale (mRS).Results The cohort was predominantly female (76.9%) with a median age of 62 years. Most aneurysms were located in the internal carotid artery (75.3%), followed by the posterior circulation (17.3%), with a mean maximum diameter of 6.2±5.4 mm; 85.2% were saccular and 95.1% unruptured, with 21.0% measuring greater than 7 mm and 11.1% previously treated. A total of 112 devices were deployed (mean 1.38 per case) via upper extremity (55.6%) or transfemoral (42.0%) access. Technical success was achieved in 100% of cases regardless of access site. Adjunctive balloon angioplasty was required in only 13.6%, substantially lower than the 26.1% reported for the Surpass Evolve, supporting the clinical benefit of the increased braid angle. Among 55 aneurysms with complete angiographic follow-up at approximately 6 months, complete occlusion (RROC I/OKM D) was achieved in 80.0% and adequate occlusion in 83.6%, comparing favorably to 62.8 to 75% reported for Pipeline and other flow diverters at similar timepoints. In-stent stenosis (<50%) was observed in only 3.6%, suggesting favorable vessel remodeling. Good functional outcome (mRS 0 to 2) was achieved in 96.3%, with 72.8% of patients discharged on postoperative day one.The intraprocedural complication rate was 2.5%: one device-related microperforation (complete recovery) and one intraoperative thrombosis (managed successfully). The 30-day complication rate was 4.9%. Procedure-related mortality was 1.2% (one stroke secondary to antiplatelet noncompliance). Subgroup analyses revealed no significant differences in occlusion or functional outcomes across access site, aneurysm size, location, or rupture status.Conclusion This first published clinical experience with the Surpass Elite demonstrates excellent technical deliverability, an 80% complete occlusion rate at 6 months, and a favorable safety profile. The halved rate of balloon angioplasty compared to the Surpass Evolve constitutes a clinically meaningful procedural advantage attributable to the modified braid architecture. These findings establish foundational evidence supporting continued evaluation in larger prospective cohorts.Disclosures O. Gandhi: None. S. Almasri: None. W. Ahmed: None. S. Dumasia: None. N. Yu: None. M. Rashad: None. L. Bagley: None. M. Fiesta: None. O. Choudhri: 2; C; Stryker Neurovascular.Abstract O-068 Table 1Summary of key outcomesOutcome MetricResultTechnical Success100% (81/81)Complete Occlusion (RROC I / OKM D)80.0% (44/55)Adequate Occlusion (RROC I-II / OKM C-D)83.6% (46/55)Balloon Angioplasty Required13.6% (11/81)Good Functional Outcome (mRS 0-2)96.3% (52/54)Intraprocedural Complication Rate2.5% (2/81)30-Day Complication Rate4.9% (4/81)In-Stent Stenosis (<50%)3.6% (2/56)Procedure-Related Mortality1.2% (1/81)",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "O Gandhi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "S Almasri"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "W Ahmed"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "S Dumasia"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "N Yu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "M Rashad"
    },
    {
      "affiliations": [
        "Department of Radiology, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "L Bagley"
    },
    {
      "affiliations": [
        "Radiology Associates of North Texas, Fort Worth, TX"
      ],
      "name": "M Fiesta"
    },
    {
      "affiliations": [
        "Department of Radiology, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "O Choudhri"
    }
  ],
  "title": "O-068 First clinical experience with the surpass elite flow diverter in the treatment of intracranial aneurysms: a multicenter series",
  "uid": "24239d98-72ac-52e3-b17e-7976076dc570"
}