Treatment of complex intracranial aneurysms using flow-diverting silk® stents. An analysis of 32 consecutive patients

Abstract

This study describes the peri-procedural and late complications and angiographic follow-up results of 32 patients with 34 complex aneurysms treated with flow diverter Silk stents in a single centre. In this retrospective study, 40 Silk stents (SS) were implanted in 34 complex intracranial aneurysms in 32 patients. In our series, 20 (58.8%) carotid-ophthalmic internal carotid artery (ICA), six (17.6%) cavernous ICA, two (5.9%) supraclinoid ICA, two (5.9%) petrosal ICA (the same patient- bilateral) and four (11.8%) posterior circulation aneurysms were treated. One of the posterior circulation lesions was a fenestrated-type aneurysm. Twenty wide-necked, saccular; eight neck remnant; four fusiform and two blister-like aneurysms were included in our series. SS were successfully implanted in all patients (100%). Misdeployment occurred in 17.6% of patients. In two of these patients adequate stent openness was achieved via Hyperglide balloon dilatation. Coil embolization in addition to SS placement was utilized in four aneurysms. One patient (3%) experienced transient morbidity due to a thromboembolic event and there was one mortality (3%) due to remote intraparenchymal haemorrhage. Complete occlusion of 27/33 (81.8 %) and 29/33 (87.9 %) aneurysms was achieved six and 12 months after the procedure, respectively. In-stent intimal hyperplasia was detected in 6.1 % patients. Flow-diverter Silk stent implantation is an effective method of treating complex aneurysms with acceptable mortality and morbidity rates. Complete occlusion is achieved in most of the complex aneurysms.

Keywords: Silk stent; cerebral aneurysms; endovascular treatment; flow diverter.

Figure 1

A) 3D angiography image demonstrating the giant complex aneurysm at right cavernosal segment of ICA of the patient lost due to remote intraparenchymal bleeding within post-procedural 40h. B) DSA image showing wide neck saccular aneurysm with slow flow (Grade 2) during the procedure.C) Native cranial CT axial image demonstrating parenchymal haemorrhage.

Figure 2

A) Pre-procedural DSA image of the patient with intimal hyperplasia at 6-month follow-up shows a carotid-ophthalmic, wide-necked aneurysm. B) Significant luminal stenosis (white arrow) due to intimal hyperplasia and incomplete occlusion of the aneurysm (black arrow) was detected during angiographic control 6 months after the procedure. DSA images of ICA obtained 12 (C) and 18 months (D) after the procedure.