title: The silk flow-diverting stent in the endovascular treatment of complex intracranial aneurysms:  technical aspects and midterm results in 24 consecutive patients.
abstract: BACKGROUND
  The flow-diverting stent is a new option in endovascular therapy specifically designed for the endovascular reconstruction of a segmentally diseased artery. The safety of flow-diverting stents is still equivocal.
  
  
  OBJECTIVE
  To evaluate the technical aspects, thromboembolic events, adjunctive therapies, and midterm results in patients with complex intracranial aneurysms treated with a flow-diverting stent (Silk; Balt Extrusion, Montmorency, France).
  
  
  METHODS
  We retrospectively examined angiographic images and clinical reports of 24 consecutive patients (29 stents) treated (n = 23) or attempted to treat (n = 1) with a flow-diverting device in 2 Finnish centers between March 2009 and October 2010.
  
  
  RESULTS
  The primary technical success rate was 67% (16/24). Adjunctive therapies were required in 6 (25%) patients, including 4 cases where intra-arterial abciximab was administered for the treatment of intraprocedural thromboembolic events. Technique-related complication rate and the 30-day mortality rate were each 4% (1/24). Follow-up imaging revealed 1 case of delayed in-stent thrombosis resulting in permanent disability of the patient, 1 asymptomatic occlusion, and 1 asymptomatic stenosis of the stented artery. Complete occlusion of the aneurysm with fully patent parent artery was observed in 16 of the 23 aneurysms (70%) where follow-up images were available.
  
  
  CONCLUSIONS
  Many previously untreatable cerebral aneurysms may be successfully treated with the Silk flow-diverting stent, but the associated risk of thromboembolic events is justifiable only if conventional endovascular or surgical treatment options are not applicable. Perioperative thromboembolic events should be prepared for and treated without unnecessary delays because they frequently respond to adjunctive medical therapy.
authors.affiliation: Department of Diagnostic Radiology, Tampere University Hospital, Tampere, Finland. olli.tahtinen@pshp.fi
authors.forename: Olli I
authors.initials: OI
authors.lastname: Tähtinen
authors.forename: Hannu I
authors.initials: HI
authors.lastname: Manninen
authors.forename: Ritva L
authors.initials: RL
authors.lastname: Vanninen
authors.forename: Janne
authors.initials: J
authors.lastname: Seppänen
authors.forename: Tero
authors.initials: T
authors.lastname: Niskakangas
authors.forename: Jaakko
authors.initials: J
authors.lastname: Rinne
authors.forename: Leo
authors.initials: L
authors.lastname: Keski-Nisula
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D047011:Silk; D015607:Stents / Q000706:statistics & numerical data; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D047011:Silk