Abstract
Introduction
Endovascular treatment of intracranial aneurysms has been an effective treatment option. In this paper, we report our experience with the Silk stent (SS) for endovascular treatment of complex intracranial aneurysms and present periprocedural events, immediate results, delayed complications, and imaging and clinical follow-up results.
Methods
We retrospectively examined angiographic images and clinical reports of 76 consecutive patients with 87 intracranial aneurysms who were treated with SSs between March 2008 and June 2011.
Results
All aneurysms could be successfully covered technically using implanted SSs, with an overall mortality of 6.6 %. Two transient morbidities (2.6 %) and three permanent morbidities due to embolic events (3.9 %) were observed. Unexpected procedural technical events occurred in 18 procedures (18/78, 23.1 %). Control angiographies were performed in all 71 patients with 82 aneurysms (100 %). Mean angiographic follow-up time was 17.5 ± 11.1 months [range 2–48 months]. Sixteen of the 71 patients with 19 aneurysms had only early angiographic controls in the first 6 months while remaining 55 patients with 63 aneurysms (77.5 %) had late controls after 6 months. Overall control angiographic occlusion rates were as follows: 87.8 % (72/82) total occlusion, 8.5 % residual aneurysm filling, and 3.7 % residual neck filling. The general in-stent stenosis rate in controls was 5.6 % and the stented parent artery occlusion rate was 4.2 %. Five (6.6 %) aneurysms ruptured after stent implantation in our series.
Conclusion
The Silk stent is an effective tool for the treatment of challenging aneurysms, which have previously demonstrated higher re-growth rates and technical problems, despite unexpected higher hemorrhage rates after treatment and deployment difficulties.
Similar content being viewed by others
References
Campi A, Ramzi N, Molyneux AJ et al (2007) Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 3:1538–1544
Lanzino G, Wakhloo AK, Fessler RD, Hartney ML, Guterman LR, Hopkins LN (1999) Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91:538–546
Wakhloo AK, Lanzino G, Lieber BB, Hopkins LN (1998) Stents for intracranial aneurysms: the beginning of a new endovascular era? Neurosurgery 43:377–379
Lieber BB, Livescu V, Hopkins LN, Wakhloo AK (2002) Particle image velocimetry assessment of stent design influence on intra-aneurysmal flow. Ann Biomed Eng 30:768–777
Lieber BB, Stancampiano AP, Wakhloo AK (1997) Alteration of hemodynamics in aneurysm models by stenting: influence of stent porosity. Ann Biomed Eng 25:460–469
Kim YH, Xu X, Lee JS (2010) The effect of stent porosity and strut shape on saccular aneurysm and its numerical analysis with lattice Boltzmann method. Ann Biomed Eng 38:2274–2292
Walcott BP, Pisapia JM, Nahed BV, Kahle KT, Ogilvy CS (2011) Early experience with flow diverting endoluminal stents for the treatment of intracranial aneurysms. J Clin Neurosci 18:891–894
Byrne JV, Beltechi R, Yarnold JA, Birks J, Kamran M (2010) Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study. PLoS One 5:1–8
Lubicz B, Collignon L, Raphaeli G, Pruvo JP, Bruneau M, De Witte O, Leclerc X (2010) Flow-diverter stent for the endovascular treatment of intracranial aneurysms: a prospective study in 29 patients with 34 aneurysms. Stroke 41:2247–2253
Kulcsár Z, Ernemann U, Wetzel SG et al (2010) High-profile flow diverter (silk) implantation in the basilar artery: efficacy in the treatment of aneurysms and the role of the perforators. Stroke 41:1690–1696
Tähtinen OI, Manninen HI, Vanninen RL et al (2011) The Silk flow diverting stent in the endovascular treatment of complex intracranial aneurysms: technical aspects and mid-term results in 24 consecutive patients. Neurosurgery (in press)
Wagner A, Cortsen M, Hauerberg J, Romner B, Wagner MP (2011) Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent. Neuroradiology (in press)
Klisch J, Turk A, Turner R, Woo HH, Fiorella D (2011) Very late thrombosis of flow-diverting constructs after the treatment of large fusiform posterior circulation aneurysms. AJNR Am J Neuroradiol 32:627–632
Szikora I, Berentei Z, Kulcsar Z et al (2010) Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol 31:1139–1147
Lylyk P, Miranda C, Ceratto R et al (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64:632–642
Turowski B, Macht S, Kulcsár Z, Hänggi D, Stummer W (2011) Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent): do we need to rethink our concepts? Neuroradiology 53:37–41
Kulcsár Z, Wetzel SG, Augsburger L, Gruber A, Wanke I, Rüfenacht DA (2010) Effect of flow diversion treatment on very small ruptured aneurysms. Neurosurgery 67:789–793
Kulcsár Z, Houdart E, Bonafé A et al (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32:20–24
Cebral JR, Mut F, Raschi M et al (2011) Aneurysm rupture following treatment with flow-diverting stents: computational hemodynamics analysis of treatment. AJNR Am J Neuroradiol 32:27–33
Fiorella D, Sadasivan C, Woo HH, Liber B (2011) Regarding “aneurysm rupture following treatment with flow-diverting stents: computational hemodynamics analysis of treatment”. AJNR Am J Neuroradiol 32:E95–E97
Conflict of interest
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Velioglu, M., Kizilkilic, O., Selcuk, H. et al. Early and midterm results of complex cerebral aneurysms treated with Silk stent. Neuroradiology 54, 1355–1365 (2012). https://doi.org/10.1007/s00234-012-1051-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-012-1051-7