Transient in-stent stenosis at mid-term angiographic follow-up in patients treated with SILK flow diverter stents: incidence, clinical significance and long-term follow-up

Essbaiheen, Fahad; AlQahtani, Hanan; Almansoori, Taleb M.; Cora, Elena Adela; Patro, Satya; Tsehmaister-Abitbul, Vered; Drake, Brian; Lesiuk, Howard; Finitsis, Stephanos; Iancu, Daniela

doi:10.1136/neurintsurg-2018-013928

Cited by 18 publications

(15 citation statements)

References 30 publications

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“…Long-term clinically significant predictors for in-stent stenosis of FDS have previously been evaluated. 12,[18][19][20][21][22] Bescke et al reported one of the highest prevalence of in-stent stenosis in their cohort with 93.4% of the patients having mild stenosis. 17 observed that 40 to 50% of the patients in their cohorts had in-stent stenosis resolution in their long-term angiographic follow-up, and in both cohorts all patients remained asymptomatic from in-stent stenosis.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device

et al. 2021

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Background Flow-diverting (FD) stents, with or without coiling, are a mainstay in endovascular treatment of intracranial aneurysms (IAs). One observed complication from flow diverter stent (FDS) insertion has been in-stent stenosis. Though previously studied in the short-term period, the long-term history of this complication has yet to be described. Methods We performed a retrospective cohort study of consecutive IAs treated with Pipeline Embolization Device (PED), with or without coiling, at our centre between September 2014 and December 2018 that had at least one digital subtraction angiogram (DSA) during follow-up. In-stent stenosis was measured from DSA images, and associated patient and procedural characteristics were analysed. Results 94 patients treated with PED for IA were identified. On initial DSA during follow-up, 52 patients (55.3%) had in-stent stenosis within the PED. Of these 52 patients, 17 had a second DSA during follow-up. In this 2nd DSA, improvement and/or stable in-stent stenosis was seen 16 patients (94.1%). One patient in this group had worsening in-stent stenosis had a vertebrobasilar junction FD stent. Of the patients without in-stent stenosis on initial DSA, 15 had a second DSA during follow-up. Only one of these patients (6.7%) had new appearance of in-stent stenosis (measuring 5%). Multivariate analysis found statin use to be predictive of in-stent stenosis (p = 0.020, Odds ratio = 0.279 and 95% confidence interval = 0.095–0.821). Conclusions In-stent stenosis after FDS placement was seen in 53.2% of cases, which had between 1–50% of stenosis. 82.4% had resolution/improvement of their stenosis. Statin use was protective of in-stent stenosis.

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Section: Discussionmentioning

confidence: 99%

Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device

et al. 2021

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“…This is a small sample size and longterm clinical outcomes are necessary for evaluating long-term safety and efficacy. Angiographic findings, such as evaluation of in-stent stenosis 27 or delayed parent artery occlusions, 28 need to be compared with previous generations. The sample did not include a significant number of giant aneurysms, where complex maneuvers are required, including telescoping devices in tortuous anatomies.…”

Section: Discussionmentioning

confidence: 99%

First multicenter experience using the Silk Vista flow diverter in 60 consecutive intracranial aneurysms: technical aspects

Martínez‐Galdámez

Onal

Cohen³

et al. 2021

J NeuroIntervent Surg

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BackgroundThe aim of this study was to assess the technical success and procedural safety of the new Silk Vista device (SV) by evaluating the intraprocedural and periprocedural complication rate after its use in several institutions worldwide.MethodsThe study involved a retrospective review of multicenter data regarding a consecutive series of patients with intracranial aneurysms, treated with the SV between September 2020 and January 2021. Clinical, intra/periprocedural and angiographic data, including approach, materials used, aneurysm size and location, device/s, technical details and initial angiographic aneurysm occlusion, were analyzed.Results60 aneurysms were treated with SV in 57 procedures. 66 devices were used, 3 removed and 63 implanted. The devices opened instantaneously in 60 out of 66 (91%) cases and complete wall apposition was achieved in 58 out of 63 (92%) devices implanted. In 4 out of 66 (6%) devices a partial opening of the distal end occurred, and in 5 (8%) devices incomplete apposition was reported. There were 3 (5%) intraprocedural thromboembolic events managed successfully with no permanent neurological morbidity, and 4 (7%) postprocedural events. There was no mortality in this study. The initial occlusion rates in the 60 aneurysms were as follows: O’Kelly–Marotta (OKM) A in 34 (57%) cases, OKM B in 15 (25%) cases, OKM C in 6 (10%) cases, and OKM D in 5 (8%) cases.ConclusionsOur study demonstrated that the use of the new flow diverter Silk Vista for the treatment of intracranial aneurysms is feasible and technically safe.

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“…In a single center study John et al 2 depicted intra-stent tissue growth in 41% of cases using PED, whereas with the SILK stent Essbaiheen et al 16 reported a 44% rate and Lubicz et al 17 up to 57%.…”

Section: Discussionmentioning

confidence: 99%

The occurrence of neointimal hyperplasia after flow-diverter implantation is associated with cardiovascular risks factors and the stent design

Caroff

Iacobucci

Rouchaud

et al. 2018

J NeuroIntervent Surg

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BackgroundNeo-intimal hyperplasia (NIH) is frequently observed after flow-diverter stent (FDS) implantation. Although mostly asymptomatic, this vascular response can sometimes lead to delayed ischemic strokes. This study intended to evaluate the factors potentially influencing the rates of NIH following FDS treatment.Material and MethodsAll aneurysm treatments performed with a Pipeline embolization device (PED) or a SILK stent from May 2011 to May 2015 were collected in a prospectively maintained database. Patient demographics, clinical, and angiographic outcomes including both digital subtraction angiography and C-arm cone-beam CT were registered. Two blind reviewers rated the presence of NIH on a binary scale (present/absent).ResultsFrom 148 patients, 63 datasets were available for analysis. Inter-reader agreement was excellent (Kappa=0.88). NIH was positively correlated with smoking, dyslipidemia, and high blood pressure, but not with aneurysm characteristics. At early follow-up (<12 months), NIH was more frequently associated with the use of the SILK stent (68%) rather than the PED (38%): P<0.02. At long-term follow-up, the NIH rate in the total population dropped from 55% to 26% with no more significant difference between the two stents. The complete occlusion rate as seen in early follow-up was higher in the SILK group with 76% vs 65% but without statistical significance (P=0.4).ConclusionNIH is a dual-vessel reaction after FDS implant. When planning a treatment in locations at risk of ischemic complications if severe NIH would occur, then the stent design should be considered. However, minimal NIH might also be needed as it is involved in aneurysm healing. Before treatment patients should be recommended best medical management of their cardiovascular risks factors to prevent an excessive NIH reaction.

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Transient in-stent stenosis at mid-term angiographic follow-up in patients treated with SILK flow diverter stents: incidence, clinical significance and long-term follow-up

Abstract: Transient ISS after FD deployment is a common asymptomatic finding on mid-term angiographic follow-up. Complete resolution or improvement at long-term follow-up is seen in most patients who are maintained on dual antiplatelet therapy.

Cited by 18 publications

References 30 publications

Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device

Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device

First multicenter experience using the Silk Vista flow diverter in 60 consecutive intracranial aneurysms: technical aspects

The occurrence of neointimal hyperplasia after flow-diverter implantation is associated with cardiovascular risks factors and the stent design

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