Midterm follow-up after embolization of intracranial aneurysms proximal to the circle of Willis with the Silk Vista flow diverter: the I-MAMA registry

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2024年4月2日

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Valerio Da Ros,
Federico Sabuzi,
Francesco D’Argento,
Alessandro Pedicelli,
Vladimir Gavrilovic,
Massimo Sponza,
Francesca Di Giuliano,
Francesco Biraschi,
Marta Iacobucci,
Giovanni Grillea,
Andrea Bartolo,
Mirko Patassini,
Paolo Remida,
Luca Quilici,
Giuseppe Faragò,
Marco Varrassi,
Nicola Cavasin,
Roberto Arpesani,
Aldo Victor Giordano,
Giuseppe Umana,
Francesco Garaci,
Roberto Floris

摘要

Purpose

The aim of this registry was to assess technical success, procedural safety and mid- to long-term follow-up results of the Silk Vista “Mama” (SVM) flow diverter (BALT, Montmorency, France) for the treatment of proximal intracranial aneurysms.

Methods

Between August 2020 and March 2022, data from nine Italian neurovascular centres were collected. Data included patients’ clinical presentation, aneurysms’ size, location and status, technical details, overall complications and mid- to long-term angiographic follow-up.

Results

Forty-eight aneurysms in 48 patients were treated using the SVM. Most aneurysms were small (≤ 10 mm: no. 29, 60%) and unruptured (no. 31, 65%); 13 aneurysms were recurrent after coiling or clipping. 37/48 aneurysms involved the internal carotid artery (77%). Optimal opening and complete wall apposition of the device were achieved in 46 out of 48 cases (96%). Four intra- or periprocedural complications occurred (two thrombotic complications successfully resolved, one cerebellar ischemia, one perirenal hematoma), without new neurological deficit. No significant intra-stent stenosis or stent displacement was observed during follow-up. No FD-related morbidity nor mortality was reported. At midterm (6–12 months) to long-term (> 12 months) follow-up, complete aneurysm occlusion (OKM D) was achieved in 76% of cases. Eighty-eight percent of patients had complete aneurysm occlusion or entry remnant (OKM D + C).

Conclusions

Our experience suggests that the new generation of low-profile SVM flow diverter for the treatment of proximal intracranial aneurysms is safe and effective, with low rates of intraprocedural complications and acceptable mid- to long-term occlusion rate.