Flow Diversion for Ophthalmic Artery Aneurysms

Fellows’ Journal Club

This is a retrospective review of 48 patients with 50 carotid-ophthalmic aneurysms in which 44 patients with 46 aneurysms were treated with flow diversion from June 2009 to June 2015. There were no permanent adverse visual outcomes. There was 1 death due to late intraparenchymal hemorrhage (2.2%). Six-month angiography showed complete occlusion in 24 of 37 patients (64.9%), and 3-year angiography results showed occlusion in 24 of 25 patients (96%).

SUMMARY

Figure 1 from paper
This 42-year-old woman underwent treatment with 3 PEDs for symptomatic left cavernous and ophthalmic segment aneurysms (shown in 3D rotation angiography, A). Immediate postdeployment early arterial lateral angiography shows both aneurysms filling (B), while late arterial phase shows contrast stasis in both aneurysms (C). After 6 months (D), 1 year (E), and 3 years (F), a lateral early arterial phase angiogram shows persistent ophthalmic aneurysm filling (black arrows), persistent ophthalmic artery filling, and a partially obliterated cavernous aneurysm with persistent filling through the posterior portion of the aneurysm. Because the aneurysm was nearly completely occluded at 3 years, a 5-year follow-up MRA was recommended for further follow-up.

Endovascular treatments of ophthalmic segment aneurysms are commonly used but visual outcomes remain a concern. We performed a retrospective review of patients with carotid-ophthalmic aneurysms treated with flow diversion from June 2009 to June 2015. The following outcomes were studied through chart review: visual outcomes, complications, postoperative stroke and intraparenchymal hemorrhage, and clinical outcomes. Angiographic outcomes were studied with angiography and MRA at 6 months, 1 year, and 3 years. We evaluated 50 carotid-ophthalmic aneurysms in 48 patients, among whom 44 patients with 46 aneurysms underwent treatment. The mean clinical follow-up was 29 ± 22 months (range, 0–65 months). There were no permanent adverse visual outcomes. There was 1 death because of late intraparenchymal hemorrhage (2.2%). Six-month angiography showed complete occlusion in 24 of 37 patients (64.9%), and 3-year angiography results showed occlusion in 24 of 25 patients (96%). In conclusion, flow diversion is a safe and effective treatment for carotid-ophthalmic aneurysms in carefully selected patients. The risk of adverse visual outcomes is low, and most aneurysms progress to complete occlusion.

 

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Flow Diversion for Ophthalmic Artery Aneurysms
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Jeffrey Ross
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