Silk flow-diverter stent for the treatment of intracranial aneurysms: a series of 58 patients with emphasis on long-term results.
OBJECTIVE
The Silk flow-diverter stent is increasingly used to treat complex intracranial aneurysms including wide-neck, fusiform aneurysms. Sparse data are available concerning long-term results of this technique. We report our 5-year experience with Silk stent treatment of intracranial aneurysms.


METHODS
A retrospective review of our prospectively maintained database identified all patients treated by the Silk stent in 2 institutions. Clinical charts, procedural data, and angiographic results were reviewed.


RESULTS
Between July 2009 and May 2014, we identified 58 patients with 70 intracranial aneurysms. Endovascular treatment was successful in 93% of patients with 32 treated with the first-generation Silk stent and 26 with the new Silk+ stent. Mean follow-up in 47 patients was 22 months. Despite an 11% delayed complication rate, overall permanent neurologic morbidity was 5.5%. All complications were seen with the first-generation Silk stent. There was no procedure-related mortality. Long-term anatomic results showed 73% with complete occlusion, 16% with neck remnants, and 11% with incomplete occlusion. No recanalization or retreatment was performed. The midterm intrastent stenosis rate was 57%, of which 60% improved or disappeared, 28% were stable, and 12% led to vessel occlusion. Seventy-four percent of stenosis and all vessel occlusions occurred with the first-generation Silk stent.


CONCLUSIONS
Endovascular treatment of complex intracranial aneurysms with the Silk stent is an effective therapeutic option. Despite a high rate of delayed complications with the first-generation stents, the current Silk+ stent appears safer. This treatment achieves a high rate of adequate and stable occlusion at long-term follow-up.
From the Department of Neuroradiology (B.L., O.V.d.E., B.M., F.A.), Erasme University Hospital, Brussels, Belgium blubicz@ulb.ac.be.
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Lubicz
From the Department of Neuroradiology (B.L., O.V.d.E., B.M., F.A.), Erasme University Hospital, Brussels, Belgium.
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Van der Elst
Department of Radiology (L.C.), Centre Hospitalier Régional Citadelle, Liège, Belgium.
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Collignon
From the Department of Neuroradiology (B.L., O.V.d.E., B.M., F.A.), Erasme University Hospital, Brussels, Belgium.
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Mine
From the Department of Neuroradiology (B.L., O.V.d.E., B.M., F.A.), Erasme University Hospital, Brussels, Belgium.
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Alghamdi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult