Silk vista baby versus pipeline embolization device for unruptured distal anterior cerebral artery aneurysms: A multicenter propensity-weighted comparative study - 28/05/26

Doi : 10.1016/j.neurad.2026.101553

Valerio Da Ros ^a, Frédéric Clarençon ^b,^c, Adam A. Dmytriw ^d,^e, Pascal Jabbour ^f, Marios Psychogios ^g, Peter Sporns ^h, Ajit S. Puri ⁱ, Ameer E. Hassan ^j, Oktay Algin ^k, Markus A. Möhlenbruch ^l, Mauro Bergui ^m, Oded Goren ⁿ, Gregoire Boulouis ^o, Takeshi Morimoto ^p, Raoul Pop ^q, Joanna WK Ho ^r, Virginia Pujol Lereis ^s, Jared Cooper ^t, Giancarlo Salsano ^u, Alessandro Sgreccia ^v, Arturo Consoli ^v,^w, Eytan Raz ^x, Julien Burel ^y, Khawaja Muhammad Baqir Hassan ^z, Zhe Ji ^aa, Riitta Rautio ^ab, Maria Ruggiero ^ac, Federico Sabuzi ^a, Stefania Proietti ^ad, Joseph Domenico Gabrieli ^ae, Michael Levitt ^af, Antonio Armando Caragliano ^ag, Christophe Cognard ^ah, Gaultier Marnat ^ai, Nicola Limbucci ^aj, Mariangela Piano ^ak, Alexis Guedon ^al, Andrea Romi ^am, Fortunato Di Caterino ^an, Mykola Vyval ^ao, Adrien Guenego ^ap, Mohamad Abdalkader ^aq, Thanh Nguyen ^ar, Vitor Mendes Pereira ^d, Ocilio Ribeiro Goncalves ^as, Erwah Kalsoum ^at, Alessandro Pedicelli ^au, Andrea M. Alexandre ^au, Luca Scarcia ^at,^⁎

on behalf of the CRETA investigators. ^¹
CRETA investigators given after Conclusion section.

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

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

^c Sorbonne University, Paris, France

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

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

^f Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

^g Diagnostic and Interventional Neuroradiology. Universitätsspital Basel. Switzerland

^h Department of Radiology and Neuroradiology. Stadtspital, Zürich, Switzerland

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

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

^k Department of Radiology, Ankara University, Ankara, Turkey

^l Interventional Neuroradiology, Department of Neuroradiology. Heidelberg University Hospital. Heidelberg, Germany

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

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

^o Department of Interventional Neuroradiology, Tours University Hospital, Tours, France

^p Department of Clinical Epidemiology. Hyogo Medical University. Japan

^q Interventional Neuroradiology Department, Strasbourg University Hospitals. Strasbourg, France

^r Department of Neurosurgery, Kwong Wah Hospital, Hong Kong

^s Servicio de Neurología Vascular, Departamento de Neurología, Fleni, Argentina

^t Department of Neurosurgery, Westchester Medical Center. New York, USA

^u UOC Neuroradiologia, Ospedale San Martino, Genova, Italy

^v Diagnostic and Interventional Neuroradiology Department, Foch Hospital, Suresnes, France

^w University of Versailles, Saint Quentin-des-Yvelines

^x Department of Radiology, NYU Langone Health, New York, New York, USA

^y Department of Radiology, Rouen University Hospital, Rouen, Normandy, France

^z Department of Neuroradiology, Lahore General Hospital, Lahore, Pakistan

^aa Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

^ab Department of Interventional Radiology, Turku University Hospital, Turku Finland

^ac Neuroradiology Unit, AUSL Romagna, Cesena, Italy

^ad Ages Cordinating Body, Roma, Italy

^ae Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy

^af Department of Neurological Surgery, University of Washington, USA

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

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

^ai Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France

^aj Interventional Neurovascular Unit, A.O.U. Careggi, Firenze, Italy

^ak Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy

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

^am Neuroradiology Unit, IRCCS Policlinico San Matteo, 27100 Pavia, Italy

^an Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France

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

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

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

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

^as Federal University of Piaui, Teresina, PI, Brazil

^at Department of Neuroradiology, Henri Mondor Hospital, Créteil, France

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

^⁎ Corresponding author at: Department of Neuroradiology. Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil. Department of Neuroradiology Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil

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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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Keywords : Distal intracranial aneurysms, Intracranial aneurysms: Flow diverter, Silk vista baby, Pipeline

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Silk vista baby versus pipeline embolization device for unruptured distal anterior cerebral artery aneurysms: A multicenter propensity-weighted comparative study - 28/05/26

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