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Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms
  1. Ian R Macdonald,
  2. Jai J S Shankar
  1. Department of Radiology, Dalhousie University, Halifax and University of Manitoba, Winnipeg, Canada
  1. Correspondence to Dr Jai J S Shankar, Department of Radiology Dalhousie University, Halifax and University of Manitoba, Winnipeg Canada ; shivajai1{at}


Background The efficacy of SILK flow diverters (SFD) in the management of cerebral aneurysms has been established. However, the risk of complications with parent artery occlusion (PAO) remains to be fully elucidated. The purpose of our study was to analyze intracranial aneurysms treated with SFDs and assess for occurrences and potential risk factors for PAO.

Materials and methods Between September 2010 and September 2017, 34 patients were treated for intracranial aneurysms using SFDs at a Canadian institution. This database was retrospectively analyzed for frequency of PAOs and statistical analysis performed for potential contributing factors.

Results Following treatment with SFDs, average clinical and imaging follow-ups were 31 and 22 months, respectively. PAOs were identified in 21% (7/34) of patients and occurred between 8 days and 1.5 years from intervention but only in 11.8% in those compliant to anti-platelet medications. These were all associated with anterior circulation aneurysms (P=0.131) and had no associated neurological deficits. Of these, 57% (4/7) had a fusiform morphology compared with only 19% (5/27) in non-occluded patients (P=0.039). The presence of clinical symptoms at the time of initial SFD intervention was significantly associated with PAO (P=0.021).

Conclusion Delayed PAO is not an uncommon outcome of flow diverter deployment and could be seen up to 1.5 years after treatment with no associated neurological deficits. Anti-platelet non-adherence remains a risk factor for PAO. Fusiform morphology of the aneurysm and symptoms at the time of intervention were associated with subsequent occlusion.

  • aneurysm
  • brain
  • device

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  • Contributors JJSS contributed to the project conception. IRM and JJJS contributed to the acquisition, analysis, and interpretation of data as well as the drafting and final approval of the manuscript. All co-authors are in agreement with the content of this manuscript and it has not been published or under consideration for publication elsewhere.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests JJSS is a proctor for SILK in Canada and has received honorarium from BALT for flow diverter proctorship. IRM has no conflicts of interest.

  • Patient consent Not required.

  • Ethics approval Nova Scotia Health Authority research ethics board (Halifax, NS, Canada).

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