Complications in the Treatment of Intracranial Aneurysms with Silk Stents: An Analysis of 30 Consecutive Patients

Abstract

<jats:p> Flow-diverting stents (Silk and PED) have radically changed the approach to intracranial aneurysm treatment from the use of endosaccular materials to use of an extraaneurysmal endoluminal device. </jats:p><jats:p> However, much debate surrounds the most appropriate indications for the use of FD stents and the problems raised by several possible complications. </jats:p><jats:p> We analysed our technical difficulties and the early (less than ten days after treatment) and late complications encountered in 30 aneurysms treated comprising 13 giant lesions, 12 large, five with maximum diameters &lt;10 mm and one blister-like aneurysm. </jats:p><jats:p> In our experience the primary indications for the use of FD stents can be the symptomatic intracavernous giant aneurysms. Although the extracavernous carotid siphon aneurysms have major risk of bleeding, FD stents are indicated clearly explaining the risks to the patient in case of severe mass effect. There is a very complex assessment for aneurysms of the vertebrobasilar circulation. </jats:p>

Silk Flow-Diverter Stent for the Treatment of Intracranial Aneurysms: A Series of 58 Patients with Emphasis on Long-Term Results

“…Recently, several flow-diverter stents, such as the Silk flow diverter (Balt Extrusion, Montmorency, France), have been released, and short-and midterm results have been published. [7][8][9][10][11][12][13][14][15] Notwithstanding the early promise of these devices, important shortcomings have been reported. First, delayed complications, either hemorrhagic or thromboembolic, are not uncommon; second, the flow-diverter stent tolerance might be considered poor because of the relatively high rates of intrastent stenosis and parent artery occlusion (PAO) during follow-up.…”

“…First, delayed complications, either hemorrhagic or thromboembolic, are not uncommon; second, the flow-diverter stent tolerance might be considered poor because of the relatively high rates of intrastent stenosis and parent artery occlusion (PAO) during follow-up. [7][8][9][10][11][12][13][14][15] To the best of our knowledge, sparse data are available about the long-term results of this technique, including stability of aneurysm occlusion and stent tolerance. These data are mandatory to define the place of flow-diverter stents in the therapeutic armamentarium of intracranial aneurysms.…”

“…Most stenoses were asymptomatic, but our rate is significantly superior compared with that in previous series. [7][8][9][10][11][12][13][14][15] Indeed, the incidence of intrastent stenosis was 7.8% in the Berge et al series, 10 6% in the Byrne et al series, 10 and 5% in the Murthy et al meta-analysis. 14 Nevertheless, the only series that is almost comparable with ours is that of Cohen et al, 15 which was also focused on this precise evaluation.…”

“…Risk factors for PAO are not very well-identified, but preexisting stenosis seems to be one of them. [7][8][9][10][11][12][13][14][15] Larger series with long-term follow-up are needed to better define patients who are at risk of such pejorative evolution. Our study has several limitations.…”

Endovascular Treatment of Intracranial Aneurysms in the Flow Diverter Era: Frequency of Use and Results in a Consecutive Series of 550 Treatments in a Single Centre

“…The preliminary results of endovascular treatment of intracranial aneurysms with flow diverters are much worse than for conventional endovascular techniques, in terms of both safety and efficacy 13,14 . In view of the high ischaemic event rate in posterior circulation aneurysms, the use of flow diverters in this location is strongly discouraged 4,5 .…”