Fish-mouthing deformation with Surpass Evolve flow diverter: 20% at 1 month, drops to 7% by 1 year

Fish-mouthing (focal end convergence) occurred in 20% of Surpass Evolve flow diverter cases at 1 month but resolved in most, falling to 7% at 1 year. Fusiform shape, multiple aneurysms, and MCA location were risk factors. Retrospective; n=94.

• Retrospective single-device study; 124 patients enrolled, 94 (115 aneurysms) completed 1-month follow-up; most aneurysms were ICA-located (93%), median size 10 mm.
• Complete aneurysm occlusion reached 87.1% at 1 year; only one patient with fish-mouthing developed a clinical symptom (mild visual disturbance), suggesting most deformations are clinically silent.
• Key limitation: retrospective design with likely single-center experience and no comparison to other flow diverters (e.g., Pipeline), limiting generalizability and causal inference about risk factors.

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