Silk Vista baby for the Treatment of Distal Anterior Cerebral Artery Aneurysms

Purpose: Treating small-caliber vessel aneurysms with flow diverters presents challenges due to narrow luminal diameters and tortuous vasculature, which make navigation and deployment of conventional devices using standard microcatheters more difficult. The Silk Vista Baby (SVB, Balt, Montmorency, France) flow diverter was developed to treat intracranial aneurysms located in smaller vessels or more distal lesions and is compatible with 0.017″ microcatheters. We present the largest multicenter analysis to date evaluating the outcomes of SVB use in unruptured distal anterior cerebral artery (DACA) aneurysms. Methods: Retrospective data from 20 centers were reviewed for patients with unruptured DACA aneurysms treated with SVB. The following were recorded: demographic information, clinical presentation, radiographic characteristics, procedural complications, and outcomes. Results: Seventy-nine patients (79 DACA aneurysms) were treated between January 2018 and December 2022; 59 were female (74.7%), and the median age was 61 years (IQR 53–67). Most aneurysms were saccular (91.7%), and 61.9% involved a branch. The median parent vessel diameter was 1.9 mm (IQR 1.7–2.1). A single stent was implanted in 97.5% of cases; 2.5% required two stents. The median imaging follow-up was 12 months (IQR 9.5–24). At the last follow-up, 76% of aneurysms showed complete or near-complete occlusion (O’Kelly–Marotta scale C or D). Overall, thromboembolic or hemorrhagic complications occurred in 14% of patients, with only 2 cases being symptomatic; mortality rate was 0%. The retreatment rate was 1.3%. Conclusion: In this multicenter series, the SVB flow diverter emerged as a safe and effective treatment option for unruptured DACA aneurysms.