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Published on: September 8, 2023
Silk Vista Baby for intracranial aneurysms: systematic review and proportional meta-analysis
Marina Vilardo1, João Paulo Liute Scarramal2, Leonardo Januario Campos Cardoso3
1Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Background:
The Silk Vista Baby (SVB) is a low profile flow diverter increasingly used to treat intracranial aneurysms (IAs), especially those in small caliber distal vessels. However, the available evidence remains limited and heterogeneous in terms of design, patient selection, use of adjunctive coiling, and follow-up protocols.
Purpose:
To systematically evaluate the safety and efficacy of SVB for IA treatment.
Data Sources:
PubMed, Scopus, and Web of Science were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)guidelines.
Study Selection:
Studies were included if they reported ≥5 patients with IAs treated with SVB, and provided clinical and angiographic outcome data.
Data Analysis:
Efficacy endpoints included adequate/complete occlusion and retreatment rates. Safety outcomes included good functional outcome (modified Rankin Scale score of 0-2), procedure related complications, morbidity, mortality, in-stent stenosis, and covered branch occlusion. Pooled proportions with 95% CIs were calculated using a random effects model.
Results:
14 observational studies (13 retrospective; one prospective) including 653 patients (65.4% women; mean age 55.3±4.4 years) with 673 aneurysms were included. Most aneurysms were unruptured (59.6%). Adequate and complete occlusion at the last follow-up was 82.68% (95% CI 75.52 to 89.85) and 71.39% (95% CI 60.78 to 82.00), respectively. Retreatment occurred in 1.46% (95% CI 0.00 to 3.16). Good functional outcome was reported in 92.90% of cases. Procedure related complications occurred in 9.32%, with 0.53% morbidity and 0.37% mortality. In-stent stenosis occurred in 7.18% of cases. Immediate covered branch occlusion occurred in 5.38% of patients, and covered branch occlusion at follow-up in 17.69%, mostly asymptomatic.
Conclusions:
In observational studies, SVB showed favorable angiographic and clinical outcomes for selected distal intracranial aneurysms. However, the available evidence was limited by retrospective study design, substantial heterogeneity, and variable follow-up, and conclusions, particularly in ruptured aneurysms, and should be interpreted with caution pending prospective comparative data.
Trial Registration:
PROSPERO CRD420251171696.
