Silk versus Pipeline for reconstructive endovascular treatment of intracranial aneurysms

1. Silk versus Pipeline for reconstructive endovascular treatment of intracranial aneurysms Kadziolka K, Estrade, Leautaud A., W. Mustafa, Pierot L. CHU REMIS Interventional Neuroradiology Department France

2. Primary experience with two types of FD stents • Beetwen January 2009 and September 2010 10 patients harboring 12 aneurysms were treated with 13 FD stents. • 3 patients were treated with 3 Pipeline ED • 7 patients were treated with 10 Silk ED

3. Aneurysm morphology

4. SILK and Pipeline • Flexible, microcatheter-delivery, self-expanding endovascular stent-like

5. Silk versus Pipeline metalic alloy • 48 braided nitinol and platinium microfilaments • 35-55% metal surface area coverage when fully deployed with proper stent/artery size (Kulcsar et al, Lubicz et al) • pore size110-250 μm • 48 • 48 braided cobalt chronium and platinium microfilaments • 30-35% metal surface area coverage when fully deployed with proper stent/artery size (Fiolrella et al, Lylyk et al, Szikora et al) • pore size 0,02-0,05 mm2

6. Deployment technique - Silk • Chalenging and difficult deployment technique. Combination of major forward pressure on the deliverywire and retraction of the microcatheter with „push and pull”of the whole system to improve correct stent opening and wall apposition in curved vessel. • Oversizing result in additional deployment problems. It is recomended to undersize stent. • Foreshortening must be taken into account during the selection of adequate stent lenght.

7. Deployment technique –Pipeline • Once protecting coil realeased combination of forward pressure on the deliverywire and retraction of the microcatheter. • It is recomended to oversize stent. • Foreshortening must be taken into account during the selection of adequate stent lenght.

8. Silk versus Pipeline • Low radial force • 48 • Important radial force

9. Silk versus Pipeline • Low resistance to twisting and folding the stent lumen • 48 • Important resistance to narrowing stent lumen

10. Silk versus Pipeline visibility • Very good visibility • Sinusoidal systems of markers • Poor visibility during deployment under fluoroscopy

11. Silk versus Pipeline recapturability-repositioning • Can be resheated, removed or repositioned up to 80% of stent been deployed • No retrival system • Once partially opened can not be resheated, can be removed. Limited repositioning. • Aligator retrival system

12. Silk versus Pipeline size selection • Many lengths 15-40 mm • Many diameters 2-5 mm • Single stent treatment available to reconstract wide neck or large fusiform aneurysm • Limited lengths up to 20 mm • Many diameters 2-5 mm • Multi-stent strategy overlapping for wide neck or large fusiform aneurysm

13. SFD or PED?Where to use? PED for reconstruction of curved parent vessels (small radius) but we should be prepared for telescopic strategy Retreatmen of previously treated aneurysms with coil and stent

14. SFD or PED?Where to use? SFD for remodeling of wide neck or long fusifom or circumferential aneurysms rather in more straight vessels Advantages of single stent strategy Possibility of increasing metal surface area coverage during deployment

15. Conclusion • From technical point of view the deployment of Silk seems more demanding and more operator dependent

16. Conclusion • Knowlage of same diferences, adventages and disadventages of two FD may play a role in patient and strategy selection as well as in decreasing deployment related complications.