Silk versus pipeline for reconstructive endovascular treatment of intracranial aneurysms
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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.

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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
Primary experience with two types of FD stents treatment of intracranial aneurysms

  • 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
Aneurysm morphology treatment of intracranial aneurysms


Silk and pipeline
SILK and Pipeline treatment of intracranial aneurysms

  • Flexible, microcatheter-delivery, self-expanding endovascular stent-like


Silk versus pipeline metalic alloy
Silk versus Pipeline treatment of intracranial aneurysmsmetalic 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


  • Deployment technique - treatment of intracranial aneurysmsSilk

    • 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.


    Deployment technique treatment of intracranial aneurysms–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.


    Silk versus pipeline
    Silk versus Pipeline treatment of intracranial aneurysms

    • Low radial force

    • 48

    • Important radial force


    Silk versus pipeline1
    Silk versus Pipeline treatment of intracranial aneurysms

    • Low resistance to twisting and folding the stent lumen

    • 48

    • Important resistance to narrowing stent lumen


    Silk versus pipeline visibility
    Silk versus Pipeline visibility treatment of intracranial aneurysms

    • Very good visibility

    • Sinusoidal systems of markers

    • Poor visibility during deployment under fluoroscopy


    Silk versus pipeline recapturability repositioning
    Silk versus Pipeline recapturability-repositioning treatment of intracranial aneurysms

    • 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
    Silk versus Pipeline treatment of intracranial aneurysmssize 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
    SFD or PED? treatment of intracranial aneurysmsWhere 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 use1
    SFD or PED? treatment of intracranial aneurysmsWhere 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
    Conclusion treatment of intracranial aneurysms

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


    Conclusion1
    Conclusion treatment of intracranial aneurysms

    • 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.


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