Vasconcellos de Oliveira Souza Natália, Benalia Vitor Hugo, Ortega Moreno Diego Alejandro, Liu Eileen, Chan Vanessa, Bharatha Aditya, Marotta Thomas R, Spears Julian, Pereira Vitor Mendes
Neurovascular Center, Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto ON, USA.
Department of Neurosurgery, Lyerly Neurosurgery, Baptist Hospital, Jacksonville, FL, USA.
Interv Neuroradiol. 2024 Dec;30(6):846-853. doi: 10.1177/15910199241285504. Epub 2024 Oct 3.
There is a lack of evidence of flow diversion (FD) safety for aneurysms treatment beyond the circle of Willis. Therefore, we provide a single-center real-world experience with the Silk Vista Baby (SVB).
A single-center database was retrospectively reviewed for aneurysms treated with SVB flow diverters. Demographic information, clinical presentation, radiographic characteristics, procedural complications, and outcomes were assessed.
About 57 patients (66.7% female, mean age 54.3 ± 13.2) encompassing 57 aneurysms were included. Overall, 40.4% were ruptured: 68.4% saccular, 17.5% blister, 8.7% fusiform, and 5.3% dissecting. The majority were in the anterior circulation (68.4%), and in 48.2% of cases, the distal vessel diameter was inferior to 2 mm. The symptomatic ischemic rate was 5.2%, with one case due to in-stent thrombosis (1.8%). There were no hemorrhagic complications. Complication rates did not differ between ruptured and unruptured lesions (p = 0.356). There were no cases of delayed aneurysm rupture, and overall mortality was 1.8%. The median follow-up time was 18 ± 12 months. In-stent stenosis rate was 10.5% (6/57), all of which were asymptomatic. At the last follow-up, 70.2% of cases had an adequate occlusion (OKM C and D), and 96.5% had an mRS of 0-2.
In our series, SVB was shown to be a safe device in the treatment of not only distal anterior circulation aneurysms but also in the management of complex posterior fossa and ruptured blister aneurysms. Multicenter studies are needed to confirm and generalize these results.
对于 Willis 环以外的动脉瘤治疗，缺乏血流导向（FD）安全性的证据。因此，我们提供了使用 Silk Vista Baby（SVB）的单中心真实世界经验。
对单中心数据库进行回顾性分析，纳入接受 SVB 血流导向装置治疗的动脉瘤患者。评估人口统计学信息、临床表现、影像学特征、手术并发症和治疗结果。
共纳入 57 例患者（女性占 66.7%，平均年龄 54.3±13.2 岁），涉及 57 个动脉瘤。总体而言，40.4%为破裂动脉瘤：囊状动脉瘤占 68.4%，水泡状动脉瘤占 17.5%，梭形动脉瘤占 8.7%，夹层动脉瘤占 5.3%。大多数动脉瘤位于前循环（68.4%），48.2%的病例中，远端血管直径小于 2mm。症状性缺血发生率为 5.2%，其中 1 例（1.8%）因支架内血栓形成导致。无出血性并发症。破裂和未破裂病变的并发症发生率无差异（p = 0.356）。无延迟性动脉瘤破裂病例，总体死亡率为 1.8%。中位随访时间为 18±12 个月。支架内狭窄率为 10.5%（6/57），均无症状。在最后一次随访时，70.2%的病例达到充分闭塞（OKM C 和 D 级），96.5%的患者改良 Rankin 量表（mRS）评分为 0 - 2 分。
在我们的系列研究中，SVB 不仅被证明是治疗远端前循环动脉瘤的安全装置，而且在治疗复杂后颅窝和破裂水泡状动脉瘤方面也是安全的。需要多中心研究来证实并推广这些结果。
