Mid- to Long-Term Outcomes of Intracranial Aneurysms Treated with the Silk Flow Diverter: A Single-Center Experience

Flow-diverting stents have emerged as a reconstructive endovascular strategy for the treatment of complex intracranial aneurysms. This study evaluates the mid- to long-term angiographic and clinical outcomes of intracranial aneurysms treated with the Silk flow-diverting stent.

Patients with intracranial aneurysms treated using the Silk flow diverter between November 2011 and June 2019 were retrospectively analyzed. Demographic data, aneurysm characteristics, procedural details, angiographic outcomes, complications, and clinical follow-up were reviewed. Aneurysm occlusion was assessed using the O'Kelly-Marotta grading scale. Receiver operating characteristic analysis was performed to evaluate factors influencing occlusion timing.

Seventy-five patients with 95 aneurysms were included. Most aneurysms were located in the anterior circulation (92%) and were saccular (94%). Complete aneurysm occlusion was achieved in 86% of aneurysms at 12 months and increased to 94% during long-term follow-up (mean follow-up, 43 ± 27 months). The overall complication rate was 11%. Mortality was 5.3%, predominantly associated with posterior circulation aneurysms. Receiver operating characteristic analysis demonstrated that aneurysm neck configuration was a significant predictor of occlusion timing, whereas aneurysm size and morphology were not.

Treatment with the Silk flow-diverting stent resulted in high and durable aneurysm occlusion rates with acceptable morbidity and mortality. Outcomes were favorable in anterior circulation aneurysms, while posterior circulation aneurysms were associated with increased risk. Aneurysm neck configuration appears to be a key determinant of occlusion timing, underscoring the importance of careful patient selection and treatment planning.