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 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 force • Silk versus Pipeline • Low resistance to • Important resistance twisting and to narrowing stent folding the stent lumen lumen Silk versus Pipeline visibility • Very good visibility • Poor visibility during • Sinusoidal systems of deployment under markers fluoroscopy Silk versus Pipeline recapturability-repositioning • Can be resheated, • Once partially opened removed or can not be resheated, repositioned up to can be removed. 80% of stent been Limited repositioning. deployed • No retrival system • Aligator retrival system Silk versus Pipeline size selection • Many lengths 15-40 mm • Limited lengths up to 20 mm • 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 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.