• Victor H C Benalia, Gustavo M Cortez, BrasilienseLeonardo B CLBCLyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA.Department of Neurosurgery, College of Medicine Tucson, University of Arizona, Tucson, Arizona, USA., Robert M Starke, Monika Killer-Oberpfalzer, Demetrius K Lopes, Peter T Kan, Raul G Nogueira, Jeremiah N Johnson, Vitor M Pereira, Craig Kilburg, Susan Khalili, and Ricardo A Hanel.
• Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA.
• Neurosurgery. 2022 Oct 1; 91 (4): 547554547-554.

BackgroundTreatment of small-caliber vessel lesions using flow diverters remains challenging because of vasculature's narrow luminal diameter and tortuosity. This in turn makes navigation and delivery of conventional devices with standard microcatheters more difficult. The Silk Vista Baby (SVB, Balt) flow diversion device was designed for ease of use in vessels with a smaller diameter, distal lesions, and 0.017 ″ microcatheter delivery systems.ObjectiveTo report the outcomes of the SVB device on the treatment of posterior inferior cerebellar artery (PICA) aneurysms.MethodsDatabases from different centers were retrospectively reviewed for PICA aneurysms treated with SVB. Demographic information, clinical presentation, radiographic characteristics, procedural complications, and immediate postprocedure outcomes were obtained.ResultsFourteen patients harboring 15 true PICA aneurysms were treated between January 2019 and June 2021. Nine were female (n = 9/14; 64.2%), and the mean age was 51 ± 14.9 years. Most patients had previously ruptured aneurysms, treated by another endovascular technique. Six aneurysms were located distally (n = 6/15; 40%). The mean neck size was 3 mm (SD 1.35, range 2.5-5 mm), whereas the mean PICA diameter was 1.6 mm (SD 0.26, range 1.5-1.7 mm). The mean length of follow-up was 6 months (SD 8.28, range 4.5-16 months). Treatment-related adverse events included 1 case of transient hypoesthesia. Two additional events were reported, but adjudicated as unrelated to the procedure. Complete occlusion, measured as Raymond-Roy class I, was achieved in all cases.ConclusionThe SVB device was safely and effectively used in the treatment of PICA aneurysms. The smaller delivery system profile reduces the risk of procedure complications and creates new treatment options for distal lesions.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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