Flow-diverter stents have been successfully used in the treatment of complex aneurysms with limited therapeutic alternatives. We report our experience using the Silk flow diverter (SFD; Balt Extrusion, Montmorency, France) for the treatment of complex aneurysms in four Argentine centers.
Methods
We conducted a retrospective review of 246 consecutive patients who were treated with the SFD at four Argentine centers between January 2009 and January 2017. The patient and aneurysm characteristics, as well as the details of the procedure, were analyzed. The angiographic and clinical findings were recorded during and immediately after the procedure and at 12-month follow-up.
Results
Angiography follow-up at 12 months was possible in 235 patients (95.5%) with 282 aneurysms. A total of 265 aneurysms (93.9%) presented with complete occlusion of the aneurysmal sac (class 1) and 17 aneurysms (6.1%) presented with partial occlusion (class 2). The 12-month clinical follow-up showed 11 patients with major events (seven, scale 2; five, scale 3; and two, scale 4). The morbidity and mortality rates were 4.2% (11/289) and 2.1% (5/289), respectively.
Conclusions
The treatment of aneurysms with the SFD was associated with a low rate of complications and a high percentage of aneurysmal occlusion. These findings suggest that SFD is an effective and safe alternative in the endovascular treatment of complex aneurysms.
DerdeynCPBarrJDBerensteinAet al.The International Subarachnoid Aneurysm Trial (ISAT): A position statement from the Executive Committee of the American Society of Interventional and Therapeutic Neuroradiology and the American Society of Neuroradiology. AJNR Am J Neuroradiol2003; 24: 1404–1408.
2.
DarsautTEBingFSalazkinIet al.Flow diverters can occlude aneurysms and preserve arterial branches: A new experimental model. AJNR Am J Neuroradiol2012; 33: 2004–2009.
3.
BrinjikjiWKallmesDFLanzinoGet al.Hospitalization costs for endovascular and surgical treatment of unruptured cerebral aneurysms in the United States are substantially higher than Medicare payments. AJNR Am J Neuroradiol2012; 33: 49–51.
4.
PierotLCognardCAnxionnatRet al.Endovascular treatment of ruptured intracranial aneurysms: Factors affecting mid-term quality anatomic results: Analysis in a prospective multicenter series of patients (CLARITY). AJNR Am J Neuroradiol2012; 33: 1475–1480.
5.
WakhlooAKLylykPde VriesJet al.Flow diverter in the treatment of intracranial aneurysms: A prospective multicenter study. AJNR Am J Neuroradiol2015; 36: 98–107.
6.
BergeJBiondiAMachiPet al.Flow-diverter Silk stent for the treatment of intracranial aneurysms: 1-year follow-up in a multicenter study. AJNR Am J Neuroradiol2012; 33: 1150–1155.
7.
PumarJBangueroACuellarHet al.Treatment of intracranial aneurysms with the SILK embolization device in a multicenter study. A retrospective data analysis. Neurosurgery2017; 81: 595–601.
8.
KallmesDFHanelRLopesDet al.International retrospective study of the Pipeline embolization device: A multicenter aneurysm treatment study. AJNR Am J Neuroradiol2015; 36: 108–115.
9.
BrigantiFLeoneGCiriloLet al.Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center. Neurosurg Focus2017; 42: E3.
10.
StraussIMaimonS. Silk flow diverter in the treatment of complex intracranial aneurysms: A single-center experience with 60 patients. Acta Neurochir (Wien)2016; 158: 247–254.
11.
SzikoraIBerenteiZKulcsárZet al.Treatment of intracranial aneurysms by functional reconstruction of the parent artery: The Budapest experience with the Pipeline embolization device. AJNR Am J Neuroradiol2010; 31: 1139–1147.
12.
ByrneJVBeltechiRYarnoldJet al.Early experience in the treatment of intra-cranial aneurysms with the Silk flow diverter: Procedural and short term outcomes. PLoS One2010; 5: e12492.
13.
BonitaRBeagleholeR. Modification of Rankin scale: Recovery of motor function after stroke. Stroke1988; 19: 1497–1500.
14.
LubiczBVan der ElstOCollignonLet al.Silk flow-diverter stent for the treatment of intracranial aneurysms: A series of 58 patients with emphasis on long-term results. AJNR Am J Neuroradiol2015; 36: 542–546.
15.
BrinjikjiWKallmesDFCloftHJet al.Patency of the anterior choroidal artery after flow-diversion treatment of internal carotid artery aneurysms. AJNR Am J Neuroradiol2015; 36: 537–541.
16.
BhogalPGanslandtOBäznerHet al.The fate of side branches covered by flow diverters—Results from 140 patients. World Neurosurg2017; 103: 789–798.
17.
NelsonPKLylykPSzikoraIet al.The Pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol2011; 32: 34–40.
18.
van RooijWJSluzewskiM. Perforator infarction after placement of a Pipeline flow-diverting stent for an unruptured A1 aneurysm. AJNR Am J Neuroradiol2010; 31: E43–E44.
19.
LylykPMirandaCCerattoRet al.Curative endovascular reconstruction of cerebral aneurysms with the Pipeline embolization device: The Buenos Aires experience. Neurosurgery2009; 64: 632–642. discussion 642–643.
20.
LinNBrouillardAMKrishnaCet al.Use of coils in conjunction with the Pipeline embolization device for treatment of intracranial aneurysms. Neurosurgery2015; 76: 142–144.
21.
TurowskiBMachtSKulcsárZet al.Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent): Do we need to rethink our concepts?Neuroradiology2011; 53: 37–41.
22.
NossekEChalifDJChakrabortySet al.Concurrent use of the Pipeline embolization device and coils for intracranial aneurysms: Technique, safety, and efficacy. J Neurosurg2015; 122: 904–911.
23.
KulcsárZErnemannUWetzelSGet al.High-profile flow diverter (Silk) implantation in the basilar artery: Efficacy in the treatment of aneurysms and the role of the perforators. Stroke2010; 41: 1690–1696.
24.
BrinjikjiWMuradMHLanzinoGet al.Endovascular treatment of intracranial aneurysms with flow diverters: A meta-analysis. Stroke2013; 44: 442–447.
25.
YeGZhangMDengLet al.Meta-analysis of the efficiency and prognosis of intracranial aneurysm treated with flow diverter devices. J Mol Neurosci2016; 59: 158–167.
26.
ArreseISarabiaRPintadoRet al.Flow-diverter devices for intracranial aneurysms: Systematic review and meta-analysis. Neurosurgery2013; 73: 193–199. discussion 199–200.
27.
BrigantiFNapoliMTortoraFet al.Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications: A retrospective data analysis. Neuroradiology2012; 54: 1145–1152.
28.
KocerNIslakCKizilkilicOet al.Flow Re-direction Endoluminal Device in treatment of cerebral aneurysms: Initial experience with short-term follow-up results. J Neurosurg2014; 120: 1158–1171.
29.
MöhlenbruchMAHerwehCJestaedtLet al.The FRED flow-diverter stent for intracranial aneurysms: Clinical study to assess safety and efficacy. AJNR Am J Neuroradiol2015; 36: 1155–1161.
30.
BrigantiFLeoneGUggaLet al.Safety and efficacy of Flow-Redirection Endoluminal Device (FRED) in the treatment of cerebral aneurysms: A single center experience. Acta Neurochirur (Wien)2016; 158: 1745–1755.
31.
FischerSAguilar-PérezMHenkesEet al.Initial experience with p64: A novel mechanically detachable flow diverter for the treatment of intracranial saccular sidewall aneurysms. AJNR Am J Neuroradiol2015; 36: 2082–2089.
32.
BrigantiFLeoneGUggaLet al.Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: A multicenter experience. J Neurointerv Surg2017; 9: 70–76.
33.
AkgulEOnanHBAkpinarSet al.The DERIVO embolization device in the treatment of intracranial aneurysms: Short- and midterm results. Word Neurosurg2016; 95: 229–240.
34.
WakhlooAKLylykPde VriesJet al.Surpass flow diverter in the treatment of intracranial aneurysms: A prospective multicenter study. AJNR Am J Neuroradiol2015; 36: 98–107.
