Silk Vista Baby versus Pipeline Embolization Device for Unruptured Distal Anterior Cerebral Artery Aneurysms: A Multicenter Propensity-Weighted Comparative Study - 11/04/26

Doi : 10.1016/j.neurad.2026.101553

Valerio Da Ros ¹, Frédéric Clarençon ^2,³, Adam A. Dmytriw ^4,⁵, Pascal Jabbour ⁶, Marios Psychogios ⁷, Peter Sporns ⁸, Ajit S. Puri ⁹, Ameer E. Hassan ¹⁰, Oktay Algin ¹¹, Markus A. Möhlenbruch ¹², Mauro Bergui ¹³, Oded Goren ¹⁴, Gregoire Boulouis ¹⁵, Takeshi Morimoto ¹⁶, Raoul Pop ¹⁷, Joanna WK Ho ¹⁸, Virginia Pujol Lereis ¹⁹, Jared Cooper ²⁰, Giancarlo Salsano ²¹, Alessandro Sgreccia ²², Arturo Consoli ^22,²³, Eytan Raz ²⁴, Julien Burel ²⁵, Khawaja Muhammad Baqir Hassan ²⁶, Zhe Ji ²⁷, Riitta Rautio ²⁸, Maria Ruggiero ²⁹, Federico Sabuzi ¹, Stefania Proietti ³⁰, Joseph Domenico Gabrieli ³¹, Michael Levitt ³², Antonio Armando Caragliano ³³, Christophe Cognard ³⁴, Gaultier Marnat ³⁵, Nicola Limbucci ³⁶, Mariangela Piano ³⁷, Alexis Guedon ³⁸, Andrea Romi ³⁹, Fortunato Di Caterino ⁴⁰, Mykola Vyval ⁴¹, Adrien Guenego ⁴², Mohamad Abdalkader ⁴³, Thanh Nguyen ⁴⁴, Vitor Mendes Pereira ⁴, Ocilio Ribeiro Goncalves ⁴⁵, Erwah Kalsoum ⁴⁶, Alessandro Pedicelli ⁴⁷, Andrea M. Alexandre ⁴⁷, Luca Scarcia ^46,^{^{†
on behalf of the CRETA investigators},}^⁎

¹ Department of Biomedicine and Prevention, University hospital of Rome “Tor Vergata”, Rome, Italy

² Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, APHP, 47, Bd de l'Hôpital, 75013, Paris, France

³ Sorbonne University, Paris, France

⁴ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada

⁵ Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Nuffield Department of Surgical Sciences, University of Oxford, UK

⁶ Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

⁷ Diagnostic and Interventional Neuroradiology. Universitätsspital Basel. Switzerland

⁸ Department of Radiology and Neuroradiology. Stadtspital, Zürich, Switzerland

⁹ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA

¹⁰ Endovascular Surgical Neuroradiology. Valley Baptist Medical Center - Harlingen, Texas, USA

¹¹ Department of Radiology, Ankara University, Ankara, Turkey

¹² Interventional Neuroradiology, Department of Neuroradiology. Heidelberg University Hospital. Heidelberg, Germany

¹³ Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Italy

¹⁴ Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA

¹⁵ Department of Interventional Neuroradiology, Tours University Hospital, Tours, France

¹⁶ Department of Clinical Epidemiology. Hyogo Medical University. Japan

¹⁷ Interventional Neuroradiology Department, Strasbourg University Hospitals. Strasbourg, France

¹⁸ Department of Neurosurgery, Kwong Wah Hospital, Hong Kong

¹⁹ Servicio de Neurología Vascular, Departamento de Neurología, Fleni, Argentina

²⁰ Department of Neurosurgery, Westchester Medical Center. New York, USA

²¹ UOC Neuroradiologia, Ospedale San Martino, Genova, Italy

²² Diagnostic and Interventional Neuroradiology Department, Foch Hospital, Suresnes, France

²³ University of Versailles, Saint Quentin-des-Yvelines

²⁴ Department of Radiology, NYU Langone Health, New York, New York, USA

²⁵ Department of Radiology, Rouen University Hospital, Rouen, Normandy, France

²⁶ Department of Neuroradiology, Lahore General Hospital, Lahore, Pakistan

²⁷ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

²⁸ Department of Interventional Radiology, Turku University Hospital, Turku Finland

²⁹ Neuroradiology Unit, AUSL Romagna, Cesena, Italy

³⁰ Ages Cordinating Body, Roma, Italy

³¹ Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy

³² Department of Neurological Surgery, University of Washington, USA

³³ Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, AOU Policlinico G. Martino, Messina, Italy

³⁴ Service de Neuroradiologie Interventionnelle et Diagnostique, Hôpital Purpan– CHU Toulouse, France

³⁵ Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France

³⁶ Interventional Neurovascular Unit, A.O.U. Careggi, Firenze, Italy

³⁷ Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy

³⁸ Department of Neuroradiology, AP-HP Nord, Hôpital Lariboisière, 75010 Paris, France

³⁹ Neuroradiology Unit, IRCCS Policlinico San Matteo, 27100 Pavia, Italy

⁴⁰ Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France

⁴¹ Research and Practical Centre for Endovascular Neuroradiology, the NAMS of Ukraine, Kyiv, Ukraine

⁴² Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium

⁴³ Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA

⁴⁴ Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA

⁴⁵ Federal University of Piaui, Teresina, PI, Brazil

⁴⁶ Department of Neuroradiology, Henri Mondor Hospital, Créteil, France

⁴⁷ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Italy

^⁎ Corresponding author. Dr. Luca Scarcia, Department of Neuroradiology. Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, Phone: +33 1 49 81 26 47, Fax: +33 0149 81 46 30 Department of Neuroradiology Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Saturday 11 April 2026

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.

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