Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent





Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent:

Abstract

Introduction
Since the flow diverters (FDs) have been introduced it is possible to treat aneurysms that are considered difficult or impossible
to treat with usual endovascular or surgical methods. It is still uncertain which aneurysms are suitable for this new treatment.
We present the periprocedural complications, immediate result, late complications, imaging follow-up at 6 and 12 months and
clinical follow-up at 2–23 months.

Methods
Twenty-two patients with 26 wide-necked or blister-like aneurysms had 23 treatments with implantation of a Silk stent. Eleven
patients had re-canalizations, and 11 patients were either untreated or had been treated for another aneurysm.


Results
Periprocedural complications were seen in four treatments (17%). However, none of these had clinical consequences. Mortality
and morbidity rates were 1 of 22 (5%) and 1 of 22 (5%), respectively. Clinical outcome was unchanged in 16 patients (72%),
3 patients improved (14%) and 3 patients worsened (14%). The end-of-procedure angiography did not show complete occlusion
of any of the aneurysms, but at 6 months follow-up angiography, 17 of 25 aneurysms (68%) were completely occluded, and at
12 months, 18 of 21 aneurysms (86%) were occluded.

Conclusion
The effect of the Silk FD in terms of occlusion of the aneurysms seems to occur mainly during the first 6 months after placement
but continues during the following time. Most delayed complications occur immediately after discontinuing the anticoagulation
medication. Considering the complexity of the aneurysms treated, the rate of complications is acceptable.

  • Content Type Journal Article
  • Category Interventional Neuroradiology
  • Pages 1-10
  • DOI 10.1007/s00234-011-0949-9
  • Authors

    • Aase Wagner, Department of Neuroradiology, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
    • Marie Cortsen, Department of Neuroradiology, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
    • John Hauerberg, Department of Neurosurgery, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
    • Bertil Romner, Department of Neurosurgery, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
    • Mathias Pedersen Wagner, Department of Neuroradiology, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark



  • This is a small patient group who underwent flow diversion with the SILK stent. 1/22 died and 1/22 had clinical deficits. 18/22 aneurysms occluded at 1 year. I do not think these results are really very good





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