Silk Vista Baby for the Treatment of Complex Posterior Inferior Cerebellar Artery Aneurysms

Flow Diversion for the Treatment of Middle Cerebral Artery Aneurysms

The invention of flow diverting stents (FDS) is a novel milestone in the field of endovascular aneurysm therapy, promoting physiological healing of the vessel segment contrary to prior deconstructive treatment strategies, such as coiling. The effects of FDS are based on changes in flow patterns, segmental wall stabilization, and the growth of a neointima. Although flow diversion is already well established for cerebral aneurysms in proximal segments, peripheral locations remain challenging. Especially the middle cerebral artery (MCA) with its predominance of non-collateralized perforators and functional end arteries that supply the eloquent areas of the brain is of major concern.The literature was reviewed for flow diversion of the MCA and antiplatelet therapy.Resulting from the special anatomical characteristics of the MCA, FDS implantation in this territory is completely different from the proximal vessel segments. Still, flow diversion represents an effective endovascular strategy, especially in otherwise non-accessible or sufficiently treatable lesions. However, the risk of ischemic adverse events might be increased. Special attention to the individual decision regarding device selection, antiplatelet regimen, and exact definition of the proximal and distal landing zone considering the jailed side branches is essential for a good angiographic and clinical outcome. · MCA aneurysms can be sufficiently treated by FDS.. · The anatomic and hemodynamic characteristics of the MCA result in an increased risk of thromboembolism.. · Individual device selection and antiplatelet regimen are essential for treatment success.. · Schüngel M, Wohlgemuth WA, Elolf E et al. Review: Flow Diversion for the Treatment of Middle Cerebral Artery Aneurysms. Rofo 2025; DOI 10.1055/a-2343-0046.

Endovascular treatment of intracranial aneurysms with silk vista baby flow diverter: A systematic review and meta-analysis

BACKGROUND

The Silk Vista Baby (SVB) flow diverter (FD) is a stent designed for small vessels ranging from 1.5 to 3.5 mm. It is the only FD deliverable through a 0.017-inch microcatheter. This systematic review and meta-analysis aimed to assess the SVB utilization in intracranial aneurysms (IAs).

METHODS

Four electronic databases, PubMed, Scopus, Embase, and Web of Science, were searched from inception to November 5th, 2024.

RESULTS

Ten studies with 359 patients with 373 IAs were included. Our results revealed a pooled complete occlusion rate of 65% (95%CI: 43%-83%), a favorable outcome rate of 94% (95%CI: 83%-100%), and a morbidity rate of 4% (95%CI: 0%-11%). Our meta-analysis revealed a pooled in-stent thrombosis rate of 2% (95%CI: 1%-5%), side branch occlusion rate of 2% (95%CI: 0%-3%), intracerebral hemorrhage (ICH) rate of 2% (95%CI: 1%-4%), and device shortening rate of 4% (95%CI: 3%-6%). The subgroup analysis showed that the complete occlusion rate (≤6: 84% [95%CI: 49%-100%] vs >6: 58% [95%CI: 41%-73%], p < .001) was higher in studies with 6-month or lower follow-up duration, and the favorable outcome rate was higher in those with greater than 6-month duration (≤6: 84% [95%CI: 73%-93%] vs >6: 97% [95%CI: 82%-100%], p < .001).

CONCLUSION

SVB is an efficient and safe therapeutic option for managing IAs. We demonstrated that it is associated with promising clinical and radiological outcomes and low rates of complications.

Flow Diversion for Endovascular Treatment of Intracranial Aneurysms: Past, Present, and Future Directions

Flow diversion for intracranial aneurysms emerged as an efficacious and durable treatment option over the last two decades. In a paradigm shift from intrasaccular aneurysm embolization to parent vessel remodeling as the mechanism of action, the proliferation of flow-diverting devices has enabled the treatment of many aneurysms previously considered untreatable. In this review, we review the history and development of flow diverters, highlight the pivotal clinical trials leading to their regulatory approval, review current devices including endoluminal and intrasaccular flow diverters, and discuss current and expanding indications for their use. Areas of clinical equipoise, including ruptured aneurysms and wide-neck bifurcation aneurysms, are summarized with a focus on flow diverters for these pathologies. Finally, we discuss future directions in flow diversion technology including bioresorbable flow diverters, transcriptomics and radiogenomics, and machine learning and artificial intelligence.

A rare dissecting anterior inferior cerebellar artery aneurysm treated with flow diversion using a silk vista baby device

BACKGROUND

Dissecting intracranial pseudoaneurysms represent a challenge for treatment both endovascularly and surgically.

METHODS

We review the treatment course of a ruptured anterior inferior cerebellar artery (AICA) dissecting pseudoaneurysm in a 50-year-old patient and review the history of dissecting aneurysms and AICA aneurysms treatment.

RESULTS

An aneurysm cure was achieved using flow diversion in the AICA. The recent introduction of flow diversion devices that can be deployed through 0.017" microcatheters represents a new avenue for treatment of aneurysms.

CONCLUSION

To the best of our knowledge this is the first published case of flow diversion in the(?) AICA to treat a dissecting aneurysm. The introduction of Silk Vista Baby and similar future devices is likely to widen the scope of aneurysm treatment utilizing flow diversion in distal distribution with small parent arteries.

Flow Diversion for the Treatment of Posterior Inferior Cerebellar Aneurysms: A Novel Classification of Posterior Inferior Cerebellar Artery Origin

BACKGROUND AND OBJECTIVES

Flow diversion (FD) for posterior circulation aneurysms, such as proximal posterior inferior cerebellar artery (PICA) aneurysms, remains "off-label" and controversial. Although there are reports of using FD in the vertebral artery (VA) to treat PICA aneurysms, the differences between structural PICA-origin variants have not been explored. We analyzed PICA aneurysms treated with FD, assessed radiographic and clinical outcomes, and presented a novel classification of the PICA origin in relationship to aneurysm anatomy.

METHODS

We performed a retrospective study of prospective data for intracranial aneurysms treated with FD at a major academic institution from 2013 to 2022. Proximal PICA aneurysms that underwent FD placement in the V4 segment of the vertebral artery were included for analysis. A literature review was performed on PubMed to evaluate previously published cases. The PICA origin was characterized by 4 distinct subtypes. Type 1 describes the PICA originating adjacent/separate to the aneurysm neck, Type 2 with the PICA originating from the aneurysm neck, Type 3 with the PICA originating from the aneurysm dome, and Type 4 (True PICA aneurysm) with the aneurysm located proximally on PICA, distal to the PICA-VA junction.

RESULTS

Thirteen proximal PICA aneurysms were identified and included in the analysis. Patients were primarily female (76.9%), with a median age of 62 years. The aneurysm median maximum diameter was 5.8 mm. From the total sample (institutional and literature review cases), type 1 had a 100% complete and near-complete occlusion rate, type 2 had 75.0%, type 3 had 88.9%, and type 4 had 75%. The overall complete and near-complete occlusion rate was 83.3% (20/24).

CONCLUSION

FD in the V4 VA segment is an effective way to treat proximal PICA aneurysms. Exploring the relationship between PICA origin is a helpful method in predicting occlusion rates for proximal PICA aneurysms and may lead to improved treatment considerations.