Article Dans Une Revue Journal de Neuroradiologie / Journal of Neuroradiology Année : 2026

Silk vista baby versus pipeline embolization device for unruptured distal anterior cerebral artery aneurysms: A multicenter propensity-weighted comparative study

Adam A. Dmytriw
  • Fonction : Auteur
Pascal Jabbour
Peter Sporns
  • Fonction : Auteur
Ameer E. Hassan
Oded Goren
Gregoire Boulouis
Takeshi Morimoto
Joanna Wk Ho
Virginia Pujol Lereis
  • Fonction : Auteur
Giancarlo Salsano
Zhe Ji
  • Fonction : Auteur
Maria Ruggiero
Stefania Proietti
  • Fonction : Auteur
Joseph Domenico Gabrieli
Michael Levitt
Antonio Armando Caragliano
Christophe Cognard
Gaultier Marnat
Nicola Limbucci
Mariangela Piano
  • Fonction : Auteur
Fortunato Di Caterino
Mykola Vyval
  • Fonction : Auteur
Adrien Guenego
  • Fonction : Auteur
Erwah Kalsoum
  • Fonction : Auteur
Alessandro Pedicelli
Andrea M. Alexandre

Résumé

Background Flow diversion is effective for unruptured distal anterior cerebral artery (DACA) aneurysms, yet comparative data between the Silk Vista Baby (SVB) and Pipeline Embolization Device (PED) in this challenging territory remain scarce. Methods We conducted a retrospective multicenter study using the CRETA Registry, including consecutive patients with unruptured DACA aneurysms treated with SVB or PED. The primary endpoint was complete angiographic occlusion (O’Kelly-Marotta grade D). Secondary outcomes included procedural characteristics, clinical outcome (modified Rankin Scale), and complications. Overlap weighting was applied to account for non-randomized treatment allocation. Predictors of occlusion were explored using penalized logistic regression. A sensitivity analysis using a reduced five-variable model was performed to assess model robustness. Results 137 patients were included (79 SVB, 58 PED). Within the PED group, devices included Pipeline Flex (n = 34), Pipeline Flex with Shield Technology (n = 14), and Pipeline Vantage with Shield Technology (n = 10). After overlap weighting, baseline characteristics were balanced; the effective sample size was 100.4. SVB procedures more often used a single device; PED frequently required multiple stents. Procedure duration was shorter with SVB. Complete occlusion was achieved in 69.6% (SVB) and 70.7% (PED) of aneurysms, with no significant difference in adjusted analysis (OR 1.32, 95% CI 0.59–2.96). Favorable clinical outcomes were observed in both groups, with acceptable and comparable complication rates. No variable, including device type, independently predicted complete occlusion, a finding confirmed in a reduced five-variable sensitivity analysis (aOR 1.04, 95% CI 0.47–2.31; p = 0.915). Conclusions SVB and PED demonstrated comparable angiographic efficacy and clinical safety for unruptured DACA aneurysms. Despite procedural differences, mid-term occlusion rates and outcomes were similar. Device selection in this distal territory may be guided primarily by anatomical considerations and operator preference rather than expectations of differential performance.

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hal-05614919 , version 1 (12-05-2026)

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Valerio da Ros, Frédéric Clarençon, Adam A. Dmytriw, Pascal Jabbour, Marios Psychogios, et al.. Silk vista baby versus pipeline embolization device for unruptured distal anterior cerebral artery aneurysms: A multicenter propensity-weighted comparative study. Journal de Neuroradiologie / Journal of Neuroradiology, 2026, 53 (4), pp.101553-101553. ⟨10.1016/j.neurad.2026.101553⟩. ⟨hal-05614919⟩
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