Efficacy and Safety of Silk Vista Baby Flow Diverter for Intracranial Aneurysms: A Systematic Review and Proportional Meta-analysis
Marina Vilardo1, Joao Paulo L. Scarramal2, Leonardo Cardoso3, AHMET GÜNKAN4, Ocilio Goncalves5, Alperen Elek6, Luca Scarcia7
1Neurology, Massachusetts General Hospital, 2Universidade Federal de Ouro Preto, 3Universidade Federal de Minas Gerais, 4University of Arizona, 5Universidade Federal do Piaui, 6Ege University Faculty of Medicine, 7Hôpitaux Universitaires Henri-Mondor
Objective:
To evaluate the safety and efficacy of Silk Vista Baby (SVB) for the treatment of intracranial aneurysms (IAs).
Background:
The SVB is a novel low-profile flow diverter increasingly used for the treatment of IAs, particularly in small-caliber or distal vessels. However, current evidence remains limited and heterogeneous regarding study design, patient selection, adjunctive coiling, and follow-up protocols.
Design/Methods:
PubMed, Scopus, and Web-of-Science were searched according to PRISMA guidelines. Studies were eligible if they included ≥5 patients treated with SVB for IAs and provided angiographic and clinical outcome. Main efficacy outcomes included adequate and complete aneurysm occlusion rates and retreatment rates. Main safety outcomes included good functional outcome (mRS 0–2), procedure-related morbidity and mortality, procedure-related complications, in-stent stenosis, and covered branch occlusion. Pooled estimates with 95% confidence intervals were calculated using a random-effects model.
Results:
Fourteen observational studies (13 retrospective;1 prospective) comprising 653 patients (65.4% female; mean age, 55.3 ± 4.4 years) with 673 IAs were included. Most aneurysms were unruptured (59.6%) and located in the anterior cerebral artery (32.8%), followed by the anterior communicating artery (16.8%) and the middle cerebral artery (14.4%). Adequate and complete occlusion at last follow-up were 82.68% (95% CI, 75.52–89.85) and 71.39% (95% CI, 60.78–82.00), respectively. The retreatment rate was 1.46% (95% CI, 0.00–3.16). Good functional outcome was reported in 92.90% (95% CI, 88.56–97.24). Procedure-related complications occurred in 9.32% (95% CI, 5.91–12.73), resulting in 0.53% morbidity (95% CI, 0.00–1.40) and 0.37% mortality (95% CI, 0.00–1.16%). In-stent stenosis and immediate covered branch occlusion were observed in 7.18% (95% CI, 0.00–16.51). Covered branch occlusion at follow-up was 17.69% (95% CI, 9.38–26.01), with the majority of cases being asymptomatic, suggesting adequacy of collateral circulation.
Conclusions:
SVB appears to be a safe and effective flow diverter for treating IAs, demonstrating high occlusion rates, favorable clinical outcomes, and low rates of retreatment and procedure-related complications.
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