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

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 48 Important radial force

Silk versus Pipeline Important resistance to narrowing stent lumen 48 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.