• José Manuel Pumar, Alexandra Banguero, Hugo Cuellar, Leopoldo Guimaraens, Javier Masso, Salvador Miralbes, Miguel Blanco-Ulla, Fernando Vazquez-Herrero, Miguel Souto, and Miguel Gelabert-Gonzalez.
• Department of Neuroradiology, Hospital Clinico Universitario, Universidad de Santiago de Compostela, Travesia de la Choupana s/n, Santiago de Compostela, Spain.
• Neurosurgery. 2017 Oct 1; 81 (4): 595-601.

BackgroundFlow-diverter technology has become an important stent-based embolization tool in the treatment of complex cerebrovascular pathology. We report here the experience of 4 Spanish centers with using the SILK flow-diverter (SFD) device.ObjectiveTo evaluate the safety and efficacy of using the SFD in the endovascular treatment of intracranial aneurysms with complex morphology.MethodsWe retrospectively examined a prospectively maintained database of patients treated with SFD devices between July 2008 and December 2013 at 1 of 4 institutions in Spain. Data regarding patient demographics, aneurysm characteristics, and technical procedure were analyzed. Angiographic and clinical findings were recorded during the procedure and at 12 months postoperatively.ResultsA total of 175 SFD devices were implanted in 157 patients (women/men: 119/38; mean, median, and range of age: 56.2, 56.7, and 19-80 years, respectively), who were treated in a delayed manner (3-6 months from the event) for 180 aneurysms (165 unruptured and 15 ruptured). Adverse events (acute and delayed) were observed in 28.7% of cases (45/157), and most were resolved (19.1%; 30/157). Six months after the procedure, total morbidity and mortality were 9.6% (15/157) and 3.2% (5/157), respectively. Long-term imaging follow-up showed complete occlusion, neck remnants, and residual aneurysm in 78.1% (100/128), 14.0% (18/128), and 7.8% (10/128) of cases, respectively.ConclusionsThe SFD device is an effective tool for the treatment of challenging aneurysms, and allows complete occlusion within a year of the procedure in most patients, with morbidity and mortality comparable to those previously reported for similar devices.Copyright © 2016 by the Congress of Neurological Surgeons.

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