High-Profile Flow Diverter (Silk) Implantation in the Basilar Artery: Efficacy in the Treatment of Aneurysms and the Role of the Perforators

• Published in: Stroke (1970) 2010-08, Vol.41 (8), p.1690-1696
• Main Authors: KULCSAR, Zsolt, ERNEMANN, Ulrike, WETZEL, Stephan G, BOCK, Alexander, GOERICKE, Sophia, PANAGIOTOPOULOS, Vasilis, FORSTING, Michael, RUEFENACHT, Daniel A, WANKE, Isabel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Cardiovascular system; Embolization, Therapeutic - instrumentation; Female; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - therapy; Male; Medical sciences; Middle Aged; Neurology; Pharmacology. Drug treatments; Radiography; Retrospective Studies; Stents; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vasodilator agents. Cerebral vasodilators
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.110.580308

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. 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. 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. 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.