Neurointervention.  2021 Nov;16(3):222-231. 10.5469/neuroint.2021.00234.

Silk® Flow Diverter Device for Intracranial Aneurysm Treatment: A Systematic Review and Meta-Analysis

Affiliations
  • 1Latin American Council of Neurocritical Care (CLaNi), Cartagena, Colombia
  • 2Center of Biomedical Research (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
  • 3Faculty of Medicine, University El Bosque, Bogota, Colombia
  • 4Department of Neurology and Critical Care Medicine, Regions Hospital, Saint Paul, MN, USA
  • 5Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
  • 6Department of Neurosurgery, All India Institute of Medical Sciences, Madhya Pradesh, India
  • 7RED LATINO, Latin American Organization of Trauma and Neurocritical Care, Bogota, Colombia

Abstract

Flow diverters have become a critical instrument for complex aneurysms treatment. However, limited data are currently available regarding short and long-term outcomes for the Silk flow diverter. The objective of the study is to determine neurological prognosis and mortality rates for the Silk flow diversion device used in intracranial aneurysms. A systematic review with meta-analysis was performed using databases. The following descriptors were used for the search: “SILK”, “Flow Diverter”, “Mortality”, and “Prognosis”. The following data were extracted: mortality, good functional outcome, Glasgow outcome scale, complete or near-complete occlusion rates, rate of retreatment, and complications (thromboembolic and hemorrhagic complications). A total of 14 studies were selected. Among the 14 studies, 13 were retrospective observational cohort studies and 1 was a prospective observational cohort study. The mortality rate was 2.84%. The clinical good outcomes rate was 93.3%. The poor outcome rate was 6.6%. The overall thromboembolic complication rate was 6.06% (95% confidence interval [CI] 0.00–6.37, P=0.12, I2=3.13%). The total hemorrhagic complication rate was 1.62% (95% CI 0.00–5.34, P=0.28, I2=1.56%). The complete aneurysm occlusion rate was 80.4% (95% CI 8.65–9.38, P<0.0001, I2=9.09%). The Silk diverter device has a good safety and efficacy profile for treating intracranial aneurysms with high complete occlusion rates.

Keyword

Aneurysm; Intracranial aneurysm; Neurosurgery; Neurosurgical procedures; Cerebrovascular circulation

Figure

  • Fig. 1. PRISMA flow chart. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PICO, patient, intervention, comparation, outcome.

  • Fig. 2. Forest plot of clinical outcome: (A) mortality, (B) good neurological outcome, (C) poor neurological outcome.

  • Fig. 3. Forest plot pooled complications: (A) thromboembolic complications, (B) hemorrhagic complication.

  • Fig. 4. Forest plot for occlusion rate of aneurysms treated with Silk device flow diversion.


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