silk versus pipeline for reconstructive endovascular treatment of intracranial aneurysms

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

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

Aneurysm morphology

SILK

Fusiform 6

Saccular 2

PIPELINE

Saccular 4

SILK and Pipeline

Flexible, microcatheter-delivery, self-

expanding endovascular stent-like

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

Chalenging and difficult deployment technique. Combination of major forward pressure on the

delivery wire 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.

Deployment technique - Silk

Once protecting coil realeased combination of

forward pressure on the delivery wire and retraction of the microcatheter.

It is recomended to oversize stent.

Foreshortening must be taken into account during the selection of adequate stent lenght.

Deployment technique – Pipeline

Silk versus Pipeline

• Low radial force

•

• 48

• Important radial force

Silk versus Pipeline

• Low resistance to twisting and folding the stent lumen

•

• 48

• Important resistance to narrowing stent lumen

Silk versus Pipeline visibility

• Very good visibility• Sinusoidal systems

of markers

• Poor visibility during deployment under fluoroscopy

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

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

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

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

Conclusion

From technical point of view the deployment of Silk seems more demanding and more operator dependent

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.