title: Silk Device for the Treatment of Intracranial Aneurysms, Part 2: Factors Related to Clinical and Angiographic Outcome.
abstract: OBJECTIVE
  To report patient and procedure-related factors affecting the angiographic and clinical outcome in patients treated with the Silk device.
  
  
  METHODS
  All patients with intracranial aneurysms in whom treatment was attempted with the Silk flow diverter by our neurovascular team between October 2010 and November 2013 were included consecutively. The data was analyzed by an independent stroke neurologist not involved in the treatment of the patients.
  
  
  RESULTS
  A total of 96 patients (64 female) with ages range from 3 to 78 were included in this study. We found that 54 of the patients were asymptomatic and 42 of them symptomatic, while 21 had a prior history of subarachnoid hemorrhage (SAH). Mean aneurysm size was 10.2 mm (range 2 to 40 mm). 2 patients died due to consequences of SAH. 3 patients developed visual decline on the follow-up, 2 of these were procedure-related. Symptomatic thromboembolic events were noted in 7 cases. Patients with aneurysms smaller than 13 mm had significantly less complications and higher occlusion rates. The complication rate was significantly high in patients admitted with symptoms. Adjunctive coiling had no impact on outcome.
  
  
  CONCLUSIONS
  Safety and efficacy of flow diversion in this series was closely related to aneurysm size and presenting symptoms. A size cut-off for safety and efficacy has not been reported before and will be useful not only for future studies but also for patient counseling in daily practice. The futility of adjunctive coiling in this series calls for reappraisal of the current recommendations for this specific device.
authors.affiliation: Ankara Numune Training and Research Hospital, Department of Radiology, Ankara, Turkey.
authors.forename: Tunca
authors.initials: T
authors.lastname: Kaya
authors.forename: Ergun
authors.initials: E
authors.lastname: Daglioglu
authors.forename: Erdem
authors.initials: E
authors.lastname: Gurkas
authors.forename: Ilkay
authors.initials: I
authors.lastname: Akmangit
authors.forename: Ahmet
authors.initials: A
authors.lastname: Peker
authors.forename: Deniz
authors.initials: D
authors.lastname: Belen
authors.forename: Dogan
authors.initials: D
authors.lastname: Dede
authors.forename: Atilla Halil
authors.initials: AH
authors.lastname: Elhan
authors.forename: Anil
authors.initials: A
authors.lastname: Arat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult