Early and midterm results of complex cerebral aneurysms treated with Silk stent

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.…”

Flow Diverters for Unruptured Internal Carotid Artery Aneurysms: Dangerous and Not Yet an Alternative for Conventional Endovascular Techniques

“…In addition, at follow-up, there remains a certain risk for delayed aneurysm rupture and delayed in-stent thrombosis. Velioglu et al 4 combined their results with those of 4 other studies and found that in Ͼ11% (22 of 197) of aneurysms treated with a flow diverter, the parent artery became occluded. We must realize that this high complication rate and high rate of unintended parent vessel occlusion concerns elective treatments of unruptured aneurysms with an often low chance of rupture or a benign natural history (cavernous sinus aneurysms) for which safer conventional treatments are available.…”