title: High-profile flow diverter (silk) implantation in the basilar artery: efficacy in the treatment of aneurysms and the role of the perforators.
abstract: OBJECTIVE
  The introduction of flow diverters (FDs) has expanded the possibilities for reconstructive treatment of difficult intracranial aneurysms. Concern remains as to the long-term patency of the perforating arteries and side branches covered during stent placement. Our purpose was to evaluate the performance of and early effect on covered branches after implantation of the Silk FD in the treatment of basilar artery aneurysms.
  
  
  METHODS
  Twelve patients with an aneurysm of the basilar artery that was treated by implantation of the Silk FD were included in our retrospective study. Both unruptured and previously ruptured, formerly untreated, and recurrent aneurysms were treated. During follow-up, patients were monitored for clinical evolution, patency of the covered vessels, and aneurysmal obliteration.
  
  
  RESULTS
  Of the 2 ruptured aneurysms, 1 was initially treated by FD implantation. The FD covered the basilar bifurcation and the origin of a P1 segment of the posterior cerebral artery in 9 cases, the origin of the superior cerebellar artery in 9, and of the anterior inferior cerebellar artery in 3. There was 1 acute basilar artery occlusion a few hours after FD implantation. During a mean follow-up of 16 weeks, 3 patients experienced a symptomatic neurologic event.
  
  
  CONCLUSIONS
  Implantation of the Silk FD in the basilar artery was feasible and well tolerated in most cases to date. However, late ischemic events affecting perforating arteries may occur after FD implantation, suggesting that the indication should be restricted to otherwise untreatable aneurysms in this location.
authors.affiliation: Department of Neuroradiology, Hirslanden Clinic, Zürich, Switzerland.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Kulcsár
authors.forename: Ulrike
authors.initials: U
authors.lastname: Ernemann
authors.forename: Stephan G
authors.initials: SG
authors.lastname: Wetzel
authors.forename: Alexander
authors.initials: A
authors.lastname: Bock
authors.forename: Sophia
authors.initials: S
authors.lastname: Goericke
authors.forename: Vasilis
authors.initials: V
authors.lastname: Panagiotopoulos
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Ruefenacht
authors.forename: Isabel
authors.initials: I
authors.lastname: Wanke
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome