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

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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Journal
Journal of Neuroradiology
Published
2026-04-12
DOI
https://doi.org/10.1016/j.neurad.2026.101553
Primary Topic
Intracranial Aneurysms: Treatment and Complications
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article
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article

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

Federico Sabuzi, Giancarlo Salsano, Fortunato Di Caterino, Luca Scarcia et al.
Journal of Neuroradiology
Intracranial Aneurysms: Treatment and Complications
article

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

Federico Sabuzi, Giancarlo Salsano, Fortunato Di Caterino, Luca Scarcia, Alessandro Pedicelli, Alessandro Sgreccia, Markus Alfred Möhlenbruch, Michael R. Levitt, Oded Goren, Joon Ho, Riitta Rautio, Joseph Domenico Gabrieli, Nicola Limbucci, Gaultier Marnat, Pascal M. Jabbour, Julien Burel, Alexis Guédon, Grégoire Boulouis, Andrea Maria Alexandre, Andrea M. Romi, Arturo Consoli, Khawaja Muhammad Baqir Hassan, Ameer E Hassan, Takeshi Morimoto, Maria Ruggiero, M Piano, Christophe Cognard, Valerio Da Ros, Antonio Armando Caragliano, Vitor Mendes Pereira, Ocílio Ribeiro Gonçalves, Virginia Pujol Lereis, Oktay Algin, Zhe Ji, Mykola Vyval, Adrien Guenego, Marios Psychogios, Frédéric Clarençon, Jared Cooper, Thanh Nguyen, Stefania Proietti, Peter Sporns, Eytan Raz, Ajit S. Puri, Mauro Bergui, Erwah Kalsoum, Raoul Pop, Mohamad Abdalkader, Adam A. Dmytriw
article en

Abstract

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.

Journal of NeuroradiologyVol. 53(4)
Université de Tours (FR), Boston University (US), University of Rome Tor Vergata (IT), St. Michael's Hospital (CA), Westchester Medical Center (US), Ankara University (TR), University of Massachusetts Chan Medical School (US), Capital Medical University (CN), University of Toronto (CA), Université de Versailles Saint-Quentin-en-Yvelines (FR), Université Paris-Est Créteil (FR), University of Washington (US), Rina Services (Italy) (IT), Heidelberg University (DE), Thomas Jefferson University Hospital (US), Kwong Wah Hospital (CN), Lahore General Hospital (PK), Turku University Hospital (FI), Erasmus Hospital (BE), University Hospital Heidelberg (DE), University Hospital of Basel (CH), Agostino Gemelli University Polyclinic (IT), Universidade Federal do Piauí (BR), Sorbonne Université (FR), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), NYU Langone Health (US), Centre Hospitalier Universitaire de Besançon (FR), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Assistance Publique – Hôpitaux de Paris (FR), Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (AR), Azienda Ospedaliero-Universitaria Careggi (IT), Hôpital Lariboisière (FR), Instituto de Neurología Cognitiva (AR), Pitié-Salpêtrière Hospital (FR), Policlinico Universitario di Catania (IT), Valley Baptist Medical Center (US), Azienda-Unita' Sanitaria Locale Di Cesena (IT), Hôpital Purpan (FR), Azienda Ospedaliera Universitaria Policlinico "G. Martino" (IT), Stadtspital Waid (CH), Ospedale Policlinico San Martino (IT), Oxford University Hospitals NHS Trust (GB), Policlinico San Matteo Fondazione (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Hôpital Foch (FR), Neurological Surgery (US), Hôpital Civil, Strasbourg (FR), Geisinger Health System (US), University of Turin (IT), Université de Rouen Normandie (FR), Université de Strasbourg (FR), Hyogo University (JP)
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