PREDICT: Precise deployment of Silk Vista Baby in confined territory: A technical note

Abstract

Flow diverters (FD) have become increasingly useful in treating complex intracranial aneurysms, particularly wide-necked and recurrent aneurysms. Their use has progressively expanded to smaller vessels beyond the circle of Willis (CoW), and Silk Vista Baby (SVB) is one such low-profile FD which stands out because of deliverability through a 0.017″ microcatheter and smoother navigability. Precise deployment of SVB, specifically, the proximal end, can be challenging in certain anatomical locations when the proximal landing zone is very short, limited by vessel bifurcation or important branches arising from the artery or its geometry. We present our series to describe our technique and rule to ‘PREDICT’ the final deployment of SVB in real time, and discuss the nuances, exceptions and bail-out strategies. Using this technique, we were able to precisely deploy SVB in distal intracranial vessels with a mean proximal landing zone as short as 2.6 mm in 80% instances, requiring bail-out strategies in only 20% cases. This rule can be reliably followed in treating complex intracranial aneurysms with SVB FD within a confined territory, until validated software-based real-time planning tools are developed.