The SURF Study: Long-term Durability and Real-World Experience in a Prospective Trial of Intracranial Aneurysm Embolization Using Fill and Finish Coils

Sunday, May 5, 2024

4:41 PM – 4:43 PM CT

Location: S405a

Presenting Author(s)

Clemens M. Schirmer, MD, PhD, MBA

Professor, Vice Chair and Program Director
Department of Neurosurgery, Geisinger, Wilkes-Barre, PA
Wilkes Barre, PA, US

Co-Author(s)

AA

Amer Al Shekhlee, n/a

SSM Health DePaul Hospital - St.Louis, Bridgeton, MO, United States
AA

Alejandro Alejandro Weitz, n/a

Neurointerventional Department, Hospital Vall d’Hebron, Barcelona, United States
MA

Michael Avery, n/a

Banner University Medical Center, Tucson, AZ
Tucson, Arizona, United States
AB

Andrew Bauer, MD

Assistant Professor of Neurosurgery
University of Oklahoma Health Sciences Center, Oklahoma City, OK
Oklahoma City, Oklahoma, United States
IC

Imram Chaudry, n/a

Prisma Health Greenville Memorial Hospital, Greenville, SC, United States
AE

Augusto Elias, n/a

Metro Health - University of Michigan Health, Wyoming, MI, United States
OG

Oded Goren, n/a

Department of Neurosurgery, Geisinger, Danville, PA, United States
AL

Alex Lüttich, n/a

Hospital Universitario Donostia, San Sebastián, Spain, United States
JM

James Milburn, n/a

Ochsner Medical Center, Jefferson, LA, United States
OZ

Osama Zaidat, n/a

Mercy Health-St. Vincent Medical Center
Toledo, Ohio, United States

Disclosure(s):

Clemens M. Schirmer, MD, PhD, MBA: route 92 / summit max: Grant/Research Support (Ongoing)

Introduction: The SURF study was a post-market, prospective, multicenter, single-arm, observational study assessing the utility of fill and finish coils for the treatment of intracranial aneurysms (IAs).

Methods: Adult patients undergoing embolization of IAs with WAVE as the final finishing coil and Penumbra SMART COIL System accounting for at least 75% of the total number of coils implanted were enrolled consecutively at 43 centers globally (NCT04106583). Primary outcomes included core lab adjudicated rate of adequate occlusion (Raymond Roy Occlusion Classification, RROC I or II) at 1-year follow-up, SAEs within 24 hours post-procedure, and device-related SAE up to 7 days or discharge.

Results: A total of 572 patients (mean age 59.5 years, 72.6% female) were enrolled between November 2019 and August 2022. Of the target aneurysms, 39.9% were ruptured, 93.7% were saccular (incl. 8.6% bilobed and 6.5% multilobed), 54.1% were wide-necked, and 11.2% were previously treated, with 35.8% and 30.4% located in the ICA and ACA, respectively. The mean IAs size was 6.6±3.45 mm. Unassisted coiling was used in 50.7% of cases. Adjunctive therapy included stent-assisted coiling (28.8%), balloon-assisted coiling (17.7%), and flow diverters or medications (5.6%). The mean packing density was 34%. RROC I or II was 87.4% post-procedure and 92.4% at 1-year follow-up. Retreatment and recanalization rates at 1-year follow-up were 10.7% and 12.6%, respectively. The SAEs occurred in 9.3% of patients within 24 hours of the procedure. Device-related SAEs occurred in 1.1% of patients up to 7 days or discharge. The rate of major ipsilateral stroke was 1.0%.

Conclusion : Treatment with Penumbra fill and finish coils results in high packing density, highly effective, and durable embolization of the IAs in a diverse, real-world population with core-lab adjudicated data. Outcomes of the SURF registry further the evidence for coiling as the modern standard of care for the IAs treatment.