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Cas clinique

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					       Silk versus Pipeline for
   reconstructive endovascular
     treatment of intracranial

Kadziolka K, Estrade, Leautaud A., W. Mustafa,
Pierot L.
                   CHU REMIS
    Interventional Neuroradiology Department
   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                PIPELINE

Fusiform 6          Saccular 4

Saccular 2
           SILK and Pipeline

 Flexible, microcatheter-delivery, self-expanding
  endovascular stent-like
                      Silk versus Pipeline
                          metalic alloy

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

 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 – Pipeline

 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.
         Silk versus Pipeline

• Low radial force   • Important radial

         Silk versus Pipeline

• Low resistance to   • Important resistance
 twisting and           to narrowing stent
 folding the stent      lumen
    Silk versus Pipeline visibility

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

• Can be resheated,    • Once partially opened
  removed or             can not be resheated,
  repositioned up to     can be removed.
  80% of stent been       Limited repositioning.

• No retrival system   • Aligator retrival system
             Silk versus Pipeline
                 size selection

• Many lengths 15-40 mm      • Limited lengths up to 20
• Many diameters 2-5 mm
                             • Many diameters 2-5 mm

• Single stent treatment     • Multi-stent strategy
  available to reconstract     overlapping for wide
  wide neck or large           neck or large fusiform
  fusiform aneurysm            aneurysm
              SFD or PED?
             Where to use?

PED for reconstruction of curved parent vessels
      (small radius)
      but we should be prepared for telescopic
      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

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

 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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