Treatment of Intracranial Aneurysms Using Flow-Diverting Silk Stents (BALT): A Single Centre Experience

Abstract

<jats:p> The Silk stent (Balt, Montmorency, France) is a retractable device designed to achieve curative reconstruction of the parent artery associated with an intracranial aneurysm. We present our initial experience with the Silk flow-diverting stent in the management and follow-up of 25 patients presenting with intracranial aneurysms. </jats:p><jats:p> Twenty-five patients (age range, 34–81 years; 24 female) were treated with the Silk flow-diverting device. Aneurysms ranged in size from small (5), large (10) and giant (10) and included wide-necked aneurysms, multiple, nonsaccular, and recurrent intracranial aneurysms. Nine aneurysms were treated for headache, 14 for mass effect. None presented with haemorrhage. All patients were pretreated with dual antiplatelet medications for at least 72 hours before surgery and continued taking both agents for at least three months after treatment. A total of 25 Silk stents were used. Control MR angiography and/or CT angiography was typically performed prior to discharge and at one, three, six and 12 months post treatment. A follow-up digital subtraction angiogram was performed between six and 19 months post treatment. </jats:p><jats:p> Complete angiographic occlusion or subtotal occlusion was achieved in 15 patients in a time frame from three days to 12 months. Three deaths and one major complication were encountered during the study period. Two patients, all with cavernous giant aneurysms, experienced transient exacerbations of preexisting cranial neuropathies and headache after the Silk treatment. Both were treated with corticosteroids, and symptoms resolved completely within a month. </jats:p><jats:p> In our experience the Silk stent has proven to be a valuable tool in the endovascular treatment of intracranial giant partially thrombosed aneurysms and aneurysms of the internal carotid artery cavernous segment presenting with mass effect. The time of complete occlusion of the aneurysms and the risk of the bleeding is currently not predictable. </jats:p>

Treatment of Intracranial Aneurysms Using the Pipeline Flow-Diverter Embolization Device: A Single-Center Experience with Long-Term Follow-Up Results

“…7,10 There have been a few series reporting the results of Silk, another flow-diverter device for the treatment of cerebral an- eurysms. 22,[35][36][37] Byrne et al 22 reported the results in 70 aneurysms, the data of which were collected retrospectively as a multicenter registry (our institution also included cases in that registry). In that study, complete occlusion was 49% in the follow-up at a mean of 4 months.…”

Vertebro-Basilar Junction Aneurysms: A Single Centre Experience and Meta-Analysis of Endovascular Treatments

“…Moreover, the rigorous blinded retrospective assessment of the clinical and radiological outcomes by authors not involved in the initial treatment guarantees a fair appraisal of the techniques discussed. eurysm [51][52][53][54][55] . A series of flow diverter devices can be placed and overlapped to aid in aneurysm thrombosis or to extend the overall construct length for particularly long aneurysms.…”

Current Trends and Results of Endovascular Treatment of Unruptured Intracranial Aneurysms at a Single Institution in the Flow-Diverter Era

“…29 This rate may be due to patient selection because the proportion of patients with treated non-ICA aneurysms in our study was lower than that in IntrePED. Other previously published studies 8,26,[32][33][34] have reported morbidity and mortality rates following FD treatment ranging from 0% to 12% and 0% to 7%, respectively. 31 During our study period, we have changed our daily practice of admitting patients with unruptured intracranial aneurysms after treatment directly to the ICU.…”