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

Abstract

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.

Flow Diversion for the Treatment of Posterior Inferior Cerebellar Aneurysms: A Novel Classification of Posterior Inferior Cerebellar Artery Origin

“…There are only 3 series with 7 proximal PICA aneurysms (the series were mostly comprised distal PICA aneurysms) that have reported this type of treatment to date in the literature. 9,11,23 Their results are promising, with 100% complete occlusion rates and without complications; however, additional studies with larger sample sizes are needed to determine its safety and feasibility, particularly in cases where there is less than 5 mm of proximal landing zone for the FD.…”

“…8 Initial experiences treating distal PICA aneurysms have been encouraging, motivating the development and use of smaller devices such as the Silk Vista Baby or the FRED Jr deployed in the PICA lumen. [9][10][11] Although safe and effective, FD use has not been shown to have conclusive results in treating proximal PICA aneurysms when deployed in the VA. 12,13 One of the controversies is that the PICA is an end-vessel without significant collaterals, which promotes gradient flow that may keep the IAs patent. 3 PICA origin in relation to the aneurysm and its impact with occlusion after FD has not been studied, which has been found to be important for aneurysms arising from other locations.…”

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

“…Despite the limited amount of data available regarding SVB, the author's results and existing SVB studies support the relative safety of this device. 2,6 In summary, flow diverter devices have significant utility in managing intracranial aneurysms. Particularly, SVB has demonstrated increasing promise in managing distal and small vessel aneurysms, where other flow diverter devices or endovascular techniques may pose significant challenge.…”

“…Despite the limited amount of data available regarding SVB, the author's results and existing SVB studies support the relative safety of this device. 2,6…”

“…The authors particularly demonstrate SVB's safety and efficacy in treating posterior inferior cerebellar artery aneurysms. 2 The major advantage of this specific device is its ability to be deployed by a 0.017 00 microcatheter, which can be used for vessels as small as 1.5 mm. The only other flow diverter device with this property is the Woven Endo-Bridge 17; however, this is limited to endosaccular use.…”