The Silk Vista Baby – The UK experience

Abstract

Background The Silk Vista Baby (SVB) flow diverter (FDS) is the only FDS deliverable via a 0.017 inch microcatheter and is specifically designed for the distal vasculature. We sought to evaluate the safety and efficacy of the SVB. Materials and Methods We performed a retrospective review to identify SVB cases at 4 tertiary neurosurgical centres within the U.K. Clinical, procedural, angiographic and follow-up data were collected. Results We identified 60 patients (35 female, 58%) of average age 54 ± 10.5 (range 30–72) with 61 aneurysms, 50 (81.9%) located in the anterior circulation. The majority of the aneurysms treated were unruptured (46, 75.4%) and saccular (46, 75.4%). Dome size was 6.2 ± 6.2 mm (range 1–36mm) and parent vessel diameter was 2.3 ± 0.4 mm (range 1.2-3.3 mm). An average number of 1.07 devices were implanted. Coils or other devices were implanted in 14 aneurysms (23.3%). At last angiographic follow-up (n = 55), 7.5 ± 4.2 months post-procedure, 32 aneurysms (57.1%) were graded as RRC I, 7 (12.5%) RRC II, and 17 RRC III (30.4%). Clinical complications, excluding death, were seen in 4 patients (6.8%) including 1 delayed aneurysm rupture and 3 symptomatic ischaemic events. Only one patient had permanent morbidity (mRS 1). 3 patients died during follow-up (5.1%); 2 deaths were related to the aneurysms (3.4%) – one ruptured dissecting MCA aneurysm, and one giant partially thrombosed posterior circulation aneurysm. 93% of patients were mRS ≤ 2 at last follow-up. Conclusion The SVB has high rates of technical success and an acceptable safety profile. Distal aneurysms may occlude slower due to relative oversizing of the devices.

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

“…30 Overall, complications and major events associated with the SVB are reported to be low, occurring in approximately 2.27% to 3.3% of cases. 14,16 Our results reinforce the safe profile of the device for the treatment of true PICA aneurysms. Of the 3 adverse events seen in our study, only 1 can be related directly to the procedure, where 1 patient developed transient hyposensitivity due to perforator occlusion.…”

“…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.…”

“…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%.…”

“…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.…”

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

“…Use of low-profile FDs in small arteries with a diameter of < 3 mm have increased recently [ 2 , 17 – 19 ]. FRED Jr’s distinctive design provides the advantage of side branch protection in complex aneurysms.…”