1. 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

2. 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

3. Aneurysm morphology
SILK
Fusiform 6
Saccular 2
PIPELINE
Saccular 4

4. SILK and Pipeline
Flexible, microcatheter-delivery, self-expanding endovascular stent-like

5. 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 size 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

6. 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.

7. 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.

8. Silk versus Pipeline
Low radial force 48
Important radial force

9. 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

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

11. 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

12. Silk versus Pipeline size selection
Many lengths 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

13. 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

14. 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

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

16. 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.