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Original research
Expanding the use of flow diverters beyond their initial indication: treatment of small unruptured aneurysms
  1. J M Pumar1,
  2. A Mosqueira1,
  3. H Cuellar2,
  4. B Dieguez1,
  5. L Guimaraens3,
  6. J Masso4,
  7. S Miralbes5,
  8. M Blanco-Ulla1,
  9. M Souto-Bayarri1,
  10. F Vazquez-Herrero1
  1. 1Department of Neuroradiology, Hospital Clinico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
  2. 2Department of Neurosurgery and Radiology, LSU Health Sciences Center, Shreveport, Louisiana, USA
  3. 3Department of Interventional Neuroradiology, Hospital General de Cataluña, Barcelona, Spain
  4. 4Department of Neuroradiology, Hospital Universitario de Donostia, San Sebastian, Spain
  5. 5Department of Neuroradiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
  1. Correspondence to Professor JM Pumar, Department of Neuroradiology, Hospital Clinico Universitario, Universidad de Santiago de Compostela, Travesía de la Choupana s/n, Santiago de Compostela, Dp 157066, Spain; josemanuel.pumar{at}


Background Experience with the endovascular treatment of unruptured small intracranial aneurysms by flow diverter devices is still limited.

Objective To assess the safety and efficacy of the SILK flow diverter (SFD) in the treatment of small unruptured cerebral aneurysms (<10 mm).

Methods We performed a retrospective review of a prospectively maintained database of patients treated with a SFD between July 2008 and December 2013 at 4 institutions in Spain to identify all patients with small unruptured aneurysms (<10 mm). Data for patient demographics, aneurysm characteristics, and technical procedures were analyzed. Angiographic and clinical findings were recorded during the procedure and at 6- and 12-month follow-ups.

Results A total of 109 small aneurysms were treated with a SFD in 104 patients (78 women; 26 men; mean, median, and range of age: 55.2, 57.1, and 19–80 years, respectively). A total of 60 patients were asymptomatic (57.7%). All except 7 aneurysms (6.4%) arose from the anterior circulation. The mean size of the aneurysms was 4.7±1.9 mm. At 6 months, the neuromorbidity and neuromortality rates were 2.9% and 0.9%, respectively. Imaging at the 12-month follow-up showed complete occlusion, neck remnants, and residual aneurysm in 88.5% (69/78), 7.7% (6/78), and 3.3% (3/78) of cases, respectively. No delayed hemorrhage occurred.

Conclusions The findings suggest that the indications for SFD can be safely extended to small intracranial aneurysms.

  • Flow Diverter
  • Aneurysm

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  • Contributors Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: JMP, LG, JM, SM, AM, HC, MS-B. Drafting the work or revising it critically for important intellectual content: MS-B, MB-U, FV-H, BD. Final approval of the version to be published: all authors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approva l SERGAS.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Available upon request from the corresponding author.