Safety and Effectiveness of an Intracranial Aneurysm Embolization System for Treating Large or Giant Wide Neck Aneurysms

The objective of this study is to determine safety and effectiveness of the Surpass Flow
Diverter (Surpass System) in the endovascular treatment of large or giant wide-necked
intracranial aneurysms in the internal carotid artery up to the terminus. The Surpass Flow
Diverter is an intracranial implant designed to be placed in a parent artery so as to divert
blood flow away from an aneurysm. Use of the Surpass System may be associated with a decrease
in neurological death or ipsilateral stroke in patients with large or giant wide-neck
aneurysms. In a given patient, the Surpass System will be deemed effective if treatment
results in complete occlusion of their aneurysm without clinically significant stenosis of
the parent artery at one year.

Inclusion Criteria:

- Age 19 to 80 years

- Subject or legal representative is willing and able to give informed consent

- Subject has a single targeted intracranial aneurysm

- Subject agrees to return to the treating Investigator for all scheduled follow up
visits and is capable of returning to the hospital for follow up

Exclusion Criteria:

- Known allergy or contraindication to aspirin, clopidogrel/Plavix, heparin, local or
general anesthesia

- Known history of life threatening allergy to contrast dye

- Known allergy to nickel, chromium cobalt, tungsten or platinum

- Subject has documented resistance to clopidogrel/Plavix

- Major surgery within previous 30 days or planned in the next 120 days after enrollment
date

- Previous intracranial implant associated with the symptomatic distribution within the
past 12 weeks prior to treatment date

- Stenting, angioplasty, or endarterectomy of an extracranial (carotid or vertebral
artery) or intracranial artery within 30 days prior to treatment date

- Any previous stenting of parent artery at or proximal to the aneurym where it would
interfere with the placement and proper apposition of the device

- Any previous coiling where it would interfere with the placement and proper apposition
of the device

- Platelet count less than 100,000 cells/mm3 or known platelet dysfunction

- More than one intracranial aneurysm (IA) that requires treatment within 12 months

- Asymptomatic extradural aneurysms requiring treatment

- Contraindication to CT scan or MRI

- Severe neurological deficit that renders the subject incapable of living independently

- Unstable neurological deficit (i.e., worsening of clinical condition in the last 30
days)

- Evidence of active infection at the time of treatment

- Dementia or psychiatric problem that prevents the patient from completing required
follow up

- Co-morbid conditions that may limit survival to less than 24 months

- Serum creatinine greater or equal to 2.5 mg/dL

- Female subjects who are pregnant or planning to become pregnant within the study
period

- Subject with anatomy not appropriate for endovascular treatment due to severe
intracranial vessel tortuosity or stenosis

- Extra-cranial stenosis or parent vessel with stenosis greater than 50% in the area
proximal to the aneurysm

- Other known serious concurrent medical conditions

- History of intracranial vasospasm not responsive to medical therapy

- Subject with an intracranial mass, or is undergoing radiation therapy for carcinoma or
sarcoma of the head or neck region

- Subject has a history of bleeding diathesis or coagulopathy, international normalized
ratio (INR) greater than 1.5, or will refuse blood transfusions

- Subject had a subarachnoid hemorrhage within 30 days prior to the enrollment date

- Subject has a non-treated arteriovenous malformation (AVM) in the territory of the
target aneurysm

- Inability to understand the study or a history of non-compliance with medical advice

- Current use of illicit substance

- Enrollment in another trial involving an investigational product

- Subject has a need for long-term use of anticoagulants (i.e., Warfarin, Dabigatran)