Comparative outcomes of surpass streamline and evolve flow diverters in intracranial aneurysms: a comprehensive systematic review and meta-analysis of location, size, and morphology

The Surpass flow diverter, including Streamline and Evolve, features a unique design optimized for improved conformability, opening, and wall apposition. Its unique pore structure allows for deployment across a wide range of arterial diameters, contributing to its high occlusion rates. The current study aims to compare the efficacy and safety of the Surpass Streamline and Evolve in treating intracranial aneurysms, with a focus on location, size, and morphology. A systematic review and meta-analysis was carried out according to the PRISMA guidelines, utilizing PubMed, Web of Science, Scopus, and Embase, from inception to August 1st, 2024. Relevant data were extracted, and data synthesis was performed using STATA v.17. The analysis included 27 studies with 1,826 patients (76.7% female; ages 28-84 years) and 2,006 intracranial aneurysms (1,743 anterior, 222 posterior; 28 blister, 20 dissecting, 116 fusiform, and 1,597 saccular). The pooled complete occlusion rate at the final follow-up was 77%, with no significant differences between anterior (80%) and posterior (64%) circulation aneurysms (P = 0.15) or small (70%) and large/giant (79%) aneurysms (P = 0.36). Morphological analysis revealed that blister, dissecting, saccular, and fusiform aneurysms had 100%, 65%, 55%, and 79% complete occlusion rates, respectively (P < 0.001). Surpass Streamline had 81% complete occlusion success versus 69% for Evolve (P = 0.04). The overall adequate occlusion rate was 90%, with Streamline at 92% and Evolve at 88% (P = 0.35). Higher occlusion rates were observed in posterior aneurysms (100% vs. 92%; P < 0.001). Large/giant aneurysms had a higher rate of adequate occlusion (100% vs. 88%; P = 0.12). Morphological analysis showed that blister and dissecting aneurysms had 100% adequate occlusion, fusiform aneurysms had 75% adequate occlusion, and saccular aneurysms had 96% adequate occlusion (P = 0.04). Mortality, complications and in-stent thrombosis were significantly reduced with Evolve (P = 0.03, 0.001 and 0.000, respectively). Our study indicates the efficacy and safety of the Surpass flow diverter for treating intracranial aneurysms, offering a satisfactory occlusion rate. The surpass Evolve was associated with a lower incidence of major complications.