Interventional Neuroradiology


, Volume 54, Issue 10, pp 1145-1152

First online:

Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis

  • Francesco BrigantiAffiliated withInterventional Neuroradiology Unit, “Federico II” University Email author 
  • , Manuela NapoliAffiliated withInterventional Neuroradiology Unit, “Federico II” University
  • , Fabio TortoraAffiliated withInstitute of Radiology, Second University of Napoli
  • , Domenico SolariAffiliated withDivision of Neurosurgery, “Federico II” University
  • , Mauro BerguiAffiliated withNeuroradiology Division, University of Torino
  • , Edoardo BoccardiAffiliated withInterventional Neuroradiology Division, Niguarda Hospital
  • , Enrico CagliariAffiliated withNeuroradiology Unit, Ospedale dell’Angelo
  • , Lucio CastellanAffiliated withDepartment of Neuroradiology, San Martino Hospital
  • , Francesco CausinAffiliated withNeuroradiology Division, City Hospital
    • , Elisa CiceriAffiliated withNeuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”
    • , Luigi CirilloAffiliated withDepartment of Neuroradiology, Bellaria-Maggiore Hospital
    • , Roberto De BlasiAffiliated withUnit of Neuroradiology and Interventional Radiology, University Hospital
    • , Luigi DelehayeAffiliated withUnit of Neuroradiology, San Giovanni Bosco Hospital
    • , Francesco Di PaolaAffiliated withDepartment of Neuroradiology, Treviso Hospital
    • , Andrea FontanaAffiliated withUnit of Biostatistics, IRCCS “Casa Sollievo della Sofferenza”
    • , Roberto GasparottiAffiliated withInstitute of Neuroradiology, University of Brescia, Ospedali Civili
    • , Giulio GuidettiAffiliated withNeuroradiology, School of Medicine, University of Rome “La Sapienza”
    • , Ignazio DivenutoAffiliated withDepartment of Radiology, “Amedeo Avogadro” University
    • , Giuseppe IannucciAffiliated withDepartment of Neuroradiology, Vicenza Hospital
    • , Maurizio IsalbertiAffiliated withDiagnostic and Interventional Neuroradiology, Fondazione IRCCS Ca` Granda, Ospedale Maggiore Policlinico
    • , Marco LeonardiAffiliated withDepartment of Neuroradiology, Bellaria-Maggiore Hospital
    • , Fernando LupoAffiliated withDepartment of Neuroradiology, “V. Fazzi” Hospital
    • , Salvatore MangiaficoAffiliated withDepartment of Neuroradiology, Careggi Hospital
    • , Andrea MantoAffiliated withDepartment of Neuroradiology, “Umberto I” Hospital
    • , Roberto MenozziAffiliated withDepartment of Neuroradiology, University of Parma
    • , Mario MutoAffiliated withNeuroradiology Unit, “A. Cardarelli” Hospital
    • , Nunzio Paolo NuzziAffiliated withUnit of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera
    • , Rosario PapaAffiliated withDiagnostic and Interventional Neuroradiology, Fondazione IRCCS Ca` Granda, Ospedale Maggiore Policlinico
    • , Benedetto PetraliaAffiliated withDepartment of Neuroradiology, Udine University Hospital
    • , Mariangela PianoAffiliated withInterventional Neuroradiology Division, Niguarda Hospital
    • , Maurizio RestaAffiliated withDepartment of Radiology and Neuroradiology, “SS. Annunziata” Hospital
    • , Riccardo PadolecchiaAffiliated withNeuroradiology Unit, “Santa Corona” Hospital
    • , Andrea SalettiAffiliated withNeuroradiology Unit, “S. Anna” Hospital
    • , Giovanni SirabellaAffiliated withNeuroradiology Unit, “Loreto Nuovo” Hospital
    • , Luca Piero Valvassori BolgèAffiliated withInterventional Neuroradiology Division, Niguarda Hospital

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We report the experiences of 25 Italian centers, analyzing intra- and periprocedural complications of endovascular treatment of intracranial aneurysms using Silk (Balt Extrusion, Montmorency, France) and pipeline embolization devices (EV3 Inc, Irvine California).


Two hundred seventy-three patients with 295 cerebral aneurysms, enrolled in 25 centers in Italy and treated with the new flow-diverter devices, were evaluated; 142 patients were treated with Silk and 130 with pipeline (in one case, both devices were used). In 14 (5.2 %) cases devices were used with coils. Aneurysm size was >15 mm in 46.9 %, 5–15 mm in 42.2 %, and <5 mm in 10.8 %. Aneurysm locations were supraclinoid internal carotid artery (ICA) in 163 cases (55.2 %), cavernous ICA in 76 (25.7 %), middle cerebral artery in 11 (3.7 %), PCoA in 6 (2 %), and ACoA in 2 (0.7 %); the vertebrobasilar system accounted for 32 cases (10.8 %) and PCA in 5 (1.7 %).


Technical adverse events occurred with 59 patients (21.6 %); 5 patients died after ischemic events, 10 to hemorrhagic complications, and 1 from external ventricular drain positioning. At 1 month, morbidity and mortality rates were 3.7 % and 5.9 %, respectively


Our retrospective study confirms that morbidity and mortality rates in treatment with FDD of unruptured wide-neck or untreatable cerebral aneurysms do not differ from those reported in the largest series.


Flow diverter device Pipeline embolization device Silk embolization device Intracranial aneurysms Endovascular treatment