Endovascular Treatment of Intracranial Aneurysms in Small Peripheral Vessel Segments—Efficacy and Intermediate Follow-Up Results of Flow Diversion With the Silk Vista Baby Low-Profile Flow Diverter

Schüngel, Marie-Sophie; Quäschling, Ulf; Weber, Erik; Struck, Matthias; Maybaum, Jens; Bailis, Nikolaos; Arlt, Felix; Richter, Cindy; Hoffmann, Karl‐Titus; Scherlach, Cordula; Schob, Stefan

doi:10.3389/fneur.2021.671915

Cited by 14 publications

(27 citation statements)

References 20 publications

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“…Major complications ranged from 1.6% to 2.3%. 14-16,28 Moreover, there were no other complications related to the treatment, and 11 patients from 24 had complete occlusions at their 3-month follow-up.…”

Section: Discussionmentioning

confidence: 90%

“…Of those, 2 were true PICA aneurysms (2/173; 1.2%). 13-16 The occlusion rate varied from 57.1% to 76% in the latest follow-up angiogram (O'Kelly Marotta C-D or Raymond-Roy I-II). Major complications ranged from 1.6% to 2.3%.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few authors have shared their experience using the SVB device to treat PICA aneurysms. 12-16 We report on 14 PICA aneurysm cases treated using SVB, focusing on technical challenges, aneurysm occlusion, and adverse events.…”

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confidence: 99%

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Silk Vista Baby for the Treatment of Complex Posterior Inferior Cerebellar Artery Aneurysms

et al. 2022

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BACKGROUND:Treatment of small-caliber vessel lesions using flow diverters remains challenging because of vasculature's narrow luminal diameter and tortuosity. This in turn makes navigation and delivery of conventional devices with standard microcatheters more difficult. The Silk Vista Baby (SVB, Balt) flow diversion device was designed for ease of use in vessels with a smaller diameter, distal lesions, and 0.017″ microcatheter delivery systems.OBJECTIVE:To report the outcomes of the SVB device on the treatment of posterior inferior cerebellar artery (PICA) aneurysms.METHODS:Databases from different centers were retrospectively reviewed for PICA aneurysms treated with SVB. Demographic information, clinical presentation, radiographic characteristics, procedural complications, and immediate postprocedure outcomes were obtained.RESULTS:Fourteen patients harboring 15 true PICA aneurysms were treated between January 2019 and June 2021. Nine were female (n = 9/14; 64.2%), and the mean age was 51 ± 14.9 years. Most patients had previously ruptured aneurysms, treated by another endovascular technique. Six aneurysms were located distally (n = 6/15; 40%). The mean neck size was 3 mm (SD 1.35, range 2.5-5 mm), whereas the mean PICA diameter was 1.6 mm (SD 0.26, range 1.5-1.7 mm). The mean length of follow-up was 6 months (SD 8.28, range 4.5-16 months). Treatment-related adverse events included 1 case of transient hypoesthesia. Two additional events were reported, but adjudicated as unrelated to the procedure. Complete occlusion, measured as Raymond-Roy class I, was achieved in all cases.CONCLUSION:The SVB device was safely and effectively used in the treatment of PICA aneurysms. The smaller delivery system profile reduces the risk of procedure complications and creates new treatment options for distal lesions.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Silk Vista Baby for the Treatment of Complex Posterior Inferior Cerebellar Artery Aneurysms

et al. 2022

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“…FD placed at the neck of the aneurysm reduces blood flow to the aneurysm by diverting the flow to the main artery and induces thrombosis [ 5 , 11 – 13 ]. FDs have been used increasingly due to its efficacy and safety profile [ 14 , 15 ]. A recent meta-analysis by Briganti et al [ 16 ] indicated that FD stenting of intracranial aneurysms achieved a good percentage of occlusion 81.5% with a low incidence of major complications (mean 8.3% range 0–23).…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience

et al. 2022

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Purpose To analyze clinical safety and efficacy of flow re-direction endoluminal device (FRED) Jr flow diverter for treatment of unruptured, ruptured, or recanalyzed aneurysms. Materials and methods Between October 2019 and February 2022, 25 patients with 31 aneurysms treated with FRED Jr were included in the study. Clinical and radiological records, procedural details, and follow-up outcomes were retrospectively evaluated. Eighteen (72%) patients were female. Median age was 48.8 (age range 9–85). Mean follow-up was 21 months (6–28 months). Location of the aneurysms were as follows; 13 in middle cerebral artery (MCA), 7 in anterior cerebral artery (ACA), 4 in posterior cerebral artery (PCA), 3 in true posterior communicating artery (PCom), 2 in anterior communicating artery (ACom), 1 in superior cerebellar artery (SCA), 1 in true ophthalmic artery. Five patients (20%) presented with acute subarachnoid hemorrhage (aSAH). Results In all procedures, FRED Jr was successfully deployed. Three true Pcom aneurysms and a true ophthalmic aneurysm were treated with FRED Jr. Three patients with two adjacent aneurysms were treated with a single FRED Jr. In two (8%) patients in-stent thrombosis occurred intraoperatively, they were treated with iv tirofiban and thrombectomy without any sequelae. Post-discharge 2 weeks later, intraparenchymal hemorrhage occurred in a patient. He was treated with surgical drainage, the clinical course was modified Rankin score (mRS) 2. Digital subtraction angiography (DSA) was performed on 16 (64%) patients with 21 (67%) aneurysms. Near complete–complete occlusion (O’Kelly–Morata grading scale (OKM C-D) was documented in 15/16 (93.7%) patients, 20/21 (95.2%) aneurysms. In nine (36%) patients, no residual filling was observed in the magnetic resonance angiography (MRA). Good clinical outcome (mRS 0–1) was achieved in 24/25 (96%) of patients. Conclusion Endovascular treatment of small cerebral aneurysms with FRED Jr is safe and effective even in complex and challenging morphologies allowing high rates of aneurysm occlusion with low periprocedural complications. Our cohort, consisting of a rate 20% acute ruptured aneurysms, is the major additive data to the published literature.

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“…Aside from the surface modification of the p48MW HPC the architectures of the SVB and the p48MW are largely comparable. Nevertheless, recent reports indicate that each of the devices may have specific suitability profiles for different cerebrovascular segments, and that time span to aneurysm occlusion post implantation may differ between both devices [ 8 , 18 ]. Therefore, the aim of this study is (a) to report our experiences with both devices for treatment of distally located cerebral aneurysms specifically focusing on their eligibility for different locations and (b) to provide a first comparison of the efficacy, clinical outcomes and angiographic outcomes after implantation of the SVB and the p48MW HPC.…”

Section: Introductionmentioning

confidence: 99%

Distal Flow Diversion with Anti-Thrombotically Coated and Bare Metal Low-Profile Flow Diverters—A Comparison

Schüngel

Hoffmann

Weber

et al. 2023

JCM

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Background and purpose: The establishment of low-profile flow diverting stents (FDS), for example, the Silk Vista Baby (SVB) and the p48MW, facilitated endovascular treatment of peripheral cerebral aneurysms. This study therefore aims to compare the performance and outcomes of the SVB with those of the p48MW HPC, with a special focus on hemodynamic aspects of peripheral segments and bifurcations. Materials and methods: The study cohort comprises 108 patients, who were either treated with the SVB or the p48MW HPC between June 2018 and April 2021. Results: Sixty patients received a SVB and forty-eight patients a p48MW HPC. The SVB was used predominantly in the AcomA-complex, and the p48MW HPC in the MCA bifurcation. Immediately after implantation, significant hemodynamic downgrading (OKM A2-A3, B1-B3, C3) was achieved in 60% in the SVB group vs. 75.1% in the p48MW HPC group. At the second follow-up, after an average of 8.8 and 10.9 months, respectively, OKM D1 was observed in 64.4% of the SVB group vs. 27.3% in the p48MW HPC group. Only 1.7% vs. 6.8% of the aneurysms remained morphologically unaltered (OKM A1). Adverse events with persisting neurologic sequalae at last follow-up were largely comparable in both groups (5.0% vs. 4.2%). Conclusion: Immediately after implantation, the p48MW HPC had a more profound hemodynamic impact than the SVB; however, early complete occlusions were achieved in a greater proportion of lesions after implantation of the uncoated SVB.

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Endovascular Treatment of Intracranial Aneurysms in Small Peripheral Vessel Segments—Efficacy and Intermediate Follow-Up Results of Flow Diversion With the Silk Vista Baby Low-Profile Flow Diverter

Cited by 14 publications

References 20 publications

Silk Vista Baby for the Treatment of Complex Posterior Inferior Cerebellar Artery Aneurysms

Silk Vista Baby for the Treatment of Complex Posterior Inferior Cerebellar Artery Aneurysms

Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience

Distal Flow Diversion with Anti-Thrombotically Coated and Bare Metal Low-Profile Flow Diverters—A Comparison

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