First multicenter experience using the Silk Vista flow diverter in 60 consecutive intracranial aneurysms: technical aspects.

BACKGROUND: The aim of this study was to assess the technical success and procedural safety of the new Silk Vista device (SV) by evaluating the intraprocedural and periprocedural complication rate after its use in several institutions worldwide. METHODS: The study involved a retrospective review of multicenter data regarding a consecutive series of patients with intracranial aneurysms, treated with the SV between September 2020 and January 2021. Clinical, intra/periprocedural and angiographic data, including approach, materials used, aneurysm size and location, device/s, technical details and initial angiographic aneurysm occlusion, were analyzed. RESULTS: 60 aneurysms were treated with SV in 57 procedures. 66 devices were used, 3 removed and 63 implanted. The devices opened instantaneously in 60 out of 66 (91%) cases and complete wall apposition was achieved in 58 out of 63 (92%) devices implanted. In 4 out of 66 (6%) devices a partial opening of the distal end occurred, and in 5 (8%) devices incomplete apposition was reported. There were 3 (5%) intraprocedural thromboembolic events managed successfully with no permanent neurological morbidity, and 4 (7%) postprocedural events. There was no mortality in this study. The initial occlusion rates in the 60 aneurysms were as follows: O'Kelly-Marotta (OKM) A in 34 (57%) cases, OKM B in 15 (25%) cases, OKM C in 6 (10%) cases, and OKM D in 5 (8%) cases. CONCLUSIONS: Our study demonstrated that the use of the new flow diverter Silk Vista for the treatment of intracranial aneurysms is feasible and technically safe.

Evidence of congenital block vertebra in Pleistocene Cave Bear (Ursus spelaeus) from Cueva de Guantes (Palencia, Spain).

OBJECTIVE: This work provides a detailed description and differential diagnosis of a Pleistocene cave bear (Ursus spelaeus). MATERIALS: The specimen was recovered at the Cueva de Guantes archaeo- paleontological site, located in the North of the Iberian Peninsula and dated to more than 30k yr BP. METHODS: The study was carried out by macroscopic and radiological analysis. RESULTS: The specimen has unusual morphology, with two vertebrae (C6-C7) connected in the ventrodorsal projection by osseous tissue, without a space or disruption between them. However, a separation is visible in the dorsoventral projection. Moreover, C7 shows a "wedge-shape" conformation. CONCLUSIONS: The lack of clear radiological and macroscopic evidence of degenerative processes and trauma suggests a congenital anomaly or pathology. The short height of the ventral margin of the block and evidence of a radiological 'waist' lead us to propose congenital block vertebra (CBV) as the most likely diagnosis. SIGNIFICANCE: The Cueva de Guantes specimen would be the first reported evidence of CBV in a Pleistocene cave bear (Ursus spelaeus). LIMITATIONS: All diagnosis of archaeological animal remains should be undertaken with caution, especially when based on partial remains, as in this case. Moreover, this specimen lacks the neural arches of C6 and C7, preventing evaluation of the vertebral foramina. SUGGESTIONS FOR FURTHER RESEARCH: Intensive review of cave bear skeletal collections is advised to find new cases and perform an epidemiological approach to the palaeopathology of cave bears.