Silk® Flow Diverter Device for Intracranial Aneurysm Treatment: A Systematic Review and Meta-analysis

Flow diverters have become a critical instrument for complex aneurysms treatment. However, limited data are currently available regarding short and long-term outcomes for the Silk flow diverter. The objective of the study is to determine neurological prognosis and mortality rates for the Silk flow diversion device used in intracranial aneurysms. A systematic review with meta-analysis was performed using databases. The following descriptors were used for the search: “SILK”, “Flow Diverter”, “Mortality”, and “Prognosis”. The following data were extracted: mortality, good functional outcome, Glasgow outcome scale, complete or near-complete occlusion rates, rate of retreatment, and complications (thromboembolic and hemorrhagic complications). A total of 14 studies were selected. Among the 14 studies, 13 were retrospective observational cohort studies and 1 was a prospective observational cohort study. The mortality rate was 2.84%. The clinical good outcomes rate was 93.3%. The poor outcome rate was 6.6%. The overall thromboembolic complication rate was 6.06% (95% confidence interval [CI] 0.00–6.37, P=0.12, I2=3.13%). The total hemorrhagic complication rate was 1.62% (95% CI 0.00–5.34, P=0.28, I2=1.56%). The complete aneurysm occlusion rate was 80.4% (95% CI 8.65–9.38, P<0.0001, I2=9.09%). The Silk diverter device has a good safety and efficacy profile for treating intracranial aneurysms with high complete occlusion rates.

Download Full-text

Flow-diverter devices in the treatment of intracranial aneurysms: A meta-analysis and systematic review

The Neuroradiology Journal ◽

10.1177/1971400915621321 ◽

2016 ◽

Vol 29 (1) ◽

pp. 66-71 ◽

Cited By ~ 45

Author(s):

Xianli Lv ◽

Hongchao Yang ◽

Peng Liu ◽

Youxiang Li

Keyword(s):

Systematic Review ◽

Intracranial Aneurysms ◽

Meta Analysis ◽

Flow Diverter ◽

Flow Diverter Devices

Download Full-text

Long-term occlusion results with SILK flow diversion in 28 aneurysms: Do recanalizations occur during follow-up?

Interventional Neuroradiology ◽

10.1177/1591019915583119 ◽

2015 ◽

Vol 21 (3) ◽

pp. 300-310 ◽

Cited By ~ 14

Author(s):

Anastasios Mpotsaris ◽

Martin Skalej ◽

Oliver Beuing ◽

Bernd Eckert ◽

Daniel Behme ◽

...

Keyword(s):

Prospective Study ◽

Intracranial Aneurysms ◽

Flow Diverter ◽

Success Rates ◽

Imaging Data ◽

Complete Occlusion ◽

Complex Aneurysms ◽

Multicenter Prospective Study

Background and purpose The purpose of this article is to report on the long-term success rates of Silk flow-diverter (FD) treatment in a multicenter prospective study for the treatment of complex aneurysms. Methods Between May 2008 and January 2011, all consecutive patients featuring complex intracranial aneurysms eligible for FD treatment with the Silk in three neurovascular centers were included. Clinical and imaging data were assessed during hospitalization and follow-up. Results Five patients were initially asymptomatic, 20 patients showed various neurological symptoms. Twenty-eight FDs were implanted in 25 patients treating 28 aneurysms. The immediate procedure-related morbidity was 8% (two of 25), mortality 0%. One procedure-related death was observed during follow-up (in-stent thrombosis). Compared to the immediate result nearly two of three aneurysms improved during follow-up; all angiographically confirmed inflow changes took place within six months after treatment. Final anatomic outcome in 24 aneurysms of 22 patients comprised 14 (59%) with complete occlusion, seven (29%) with a neck remnant, two (8%) with residual filling <50%, none with residual filling >50% and one (4%) unchanged in comparison to its pretreatment status. Postinterventional recanalizations were seen in three of 13 (23%) aneurysms treated with FD alone; none were observed in 15 aneurysms treated with adjunctive coiling. Conclusion Anatomic presentation and location are key for successful FD treatment. The rate of successful occlusion increases during follow-up. Postinterventional monitoring for at least six months is paramount, as anatomic outcome is not reliably predictable and recanalizations may occur in initially completely occluded aneurysms.

Download Full-text

Treatment of Complex Intracranial Aneurysms Using Flow-Diverting Silk® Stents An Analysis of 32 Consecutive Patients

Interventional Neuroradiology ◽

10.15274/inr-2014-10070 ◽

2014 ◽

Vol 20 (6) ◽

pp. 729-735 ◽

Cited By ~ 10

Author(s):

Ramazan Buyukkaya ◽

Hasan Kocaeli ◽

Nalan Yildirim ◽

Hakan Cebeci ◽

Cüneyt Erdogan ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Flow Diverter ◽

Late Complications ◽

Posterior Circulation ◽

Mortality And Morbidity ◽

Complete Occlusion ◽

Complex Aneurysms ◽

Silk Stent ◽

Intraparenchymal Haemorrhage ◽

Posterior Circulation Aneurysms

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.

Download Full-text

Safety and Efficacy of Low-Profile, Self-Expandable Stents for Treatment of Intracranial Aneurysms: Initial and Midterm Results - A Systematic Review and Meta-Analysis

Interventional Neurology ◽

10.1159/000471890 ◽

2017 ◽

Vol 6 (3-4) ◽

pp. 170-182 ◽

Cited By ~ 9

Author(s):

Su-Yeon Park ◽

Jae-Sang Oh ◽

Hyuk-Jin Oh ◽

Seok-Mann Yoon ◽

Hack-Gun Bae

Keyword(s):

Systematic Review ◽

Recurrence Rate ◽

Complication Rate ◽

Intracranial Aneurysms ◽

Meta Analysis ◽

Dissecting Aneurysm ◽

Class I ◽

Class Iii ◽

Low Profile

Low-profile stents seem to be associated with a higher incidence of thromboembolic events compared with preexisting stents. We conducted a systematic review of 11 eligible reports and a meta-analysis of 7 reports with respect to the clinical efficacy and safety of low-profile stents. There were 217 intracranial aneurysms reported; 22% were ruptured aneurysms. In all, 72% were treated using single stenting, 19% were treated using overlapping stenting, and 6% were treated using balloon angioplasty followed by stenting; 3% were used to assess the flow diverter effect in a dissecting aneurysm or were treated using unexpected subtotal coil packing. On immediate postprocedural angiographic results, Raymond class I and II obliteration was obtained in 87% of the aneurysms. On angiographic results at 3-6 months, Raymond class I and II obliteration or stability was obtained in 79% of the aneurysms, and Raymond class III obliteration was obtained in 3% of the aneurysms. The recurrence rate on follow-up of intracranial aneurysms was 6.5% (5.7% with LEO Baby and 1.3% with LVIS Jr). The periprocedural complication rate was 12.4%. Periprocedural thromboembolism occurred in 6.5% of the cases. The rate of in-stent stenosis on follow-up of intracranial aneurysms was 10%. In the midterm result, the recurrence rate with use of low-profile, self-expandable stents was relatively low compared to that with use of other self-expandable stents. In the meta-analysis comparing LEO Baby with LVIS Jr, the obliteration rate at 6 months was not significantly different, but the periprocedural complication rate was relatively low with LVIS Jr.

Download Full-text

Acutely Ruptured Intracranial Aneurysms Treated with Flow-Diverter Stents: A Systematic Review and Meta-Analysis

American Journal of Neuroradiology ◽

10.3174/ajnr.a5730 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1669-1675 ◽

Cited By ~ 39

Author(s):

F. Cagnazzo ◽

D.T. di Carlo ◽

M. Cappucci ◽

P.-H. Lefevre ◽

V. Costalat ◽

...

Keyword(s):

Systematic Review ◽

Intracranial Aneurysms ◽

Meta Analysis ◽

Flow Diverter ◽

Ruptured Intracranial Aneurysms

Download Full-text

Long-Term Efficacy of Clipping Versus Coiling of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.3258680 ◽

2018 ◽

Author(s):

Alexander F. Hulsbergen ◽

Lida Mirzaei ◽

Arthur T. Van der Boog ◽

Timothy R. Smith ◽

Ivo S. Muskens ◽

...

Keyword(s):

Systematic Review ◽

Intracranial Aneurysms ◽

Meta Analysis ◽

Term Efficacy

Download Full-text

Treatment of Middle Cerebral Artery Aneurysms with Flow-Diverter Stents: A Systematic Review and Meta-Analysis

American Journal of Neuroradiology ◽

10.3174/ajnr.a5388 ◽

2017 ◽

Vol 38 (12) ◽

pp. 2289-2294 ◽

Cited By ~ 35

Author(s):

F. Cagnazzo ◽

D. Mantilla ◽

P.-H. Lefevre ◽

C. Dargazanli ◽

G. Gascou ◽

...

Keyword(s):

Systematic Review ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Meta Analysis ◽

Flow Diverter ◽

Middle Cerebral Artery Aneurysms

Download Full-text

Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

Interventional Neuroradiology ◽

10.1177/15910199211027991 ◽

2021 ◽

pp. 159101992110279

Author(s):

Muhammad Waqas ◽

Rimal H Dossani ◽

Modhi Alkhaldi ◽

Jocelyn Neveu ◽

Justin M Cappuzzo ◽

...

Keyword(s):

Systematic Review ◽

Intracranial Aneurysms ◽

Flow Diverter ◽

Complication Rates ◽

Mesh Terms ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Layered Flow ◽

Comparative Safety

Introduction The Flow Redirection Endoluminal Device (FRED; MicroVention) is a dual-layered flow diverter used for the treatment of intracranial aneurysms. The objective of this systematic review was to compile device-related safety and effectiveness data. Methods The literature from January 1, 2013 to April 30, 2021 was searched for studies describing use of the FRED for intracranial aneurysm treatment irrespective of aneurysm location and morphology. The review included anterior and posterior circulation ruptured and unruptured saccular, fusiform or dissection, and blister aneurysms. MeSH terms related to “flow re-direction endoluminal device” and “FRED for aneurysms” were used. Data related to indication, complications, and rates of aneurysm occlusion were retrieved and analyzed. Results Twenty-two studies with 1729 intracranial aneurysms were included in this review. Overall reported morbidity was 3.9% (range 0–20%). Overall procedure-related mortality was 1.4% (range 0–6%). Complication rates fell into 5 categories: technical (3.6%), ischemic (3.8%), thrombotic or stenotic (6%), hemorrhagic (1.5%), and non-neurological (0.8%). The aneurysm occlusion rate between 0 and 3 months (reported in 11 studies) was 47.8%. The occlusion rate between 4 and 6 months (reported in 14 studies) was 73.8%. Occlusion rates continued to increase to 75.1% at 7–12 months (reported in 10 studies) and 86.6% for follow-up beyond 1 year (reported in 10 studies). Conclusion This review indicated that the FRED is a safe and effective for the treatment of intracranial aneurysms. Future studies should directly compare the FRED with other flow diverters for a better understanding of comparative safety and effectiveness among the different devices.

Download Full-text