703 Identifying Unruptured Cavernous Internal Carotid Artery Aneurysms Growth and Rupture Over Time

Abstract

INTRODUCTION: Aneurysms in the Cavernous Segment of the Internal Carotid Artery (ICA) often present in an indolent fashion with limited morbidity. However, their growth progression and possible rupture over time remains poorly defined, thereby limiting optimization of serial follow-up. METHODS: We identified a retrospective cohort of 179 patients with cavernous ICA aneurysms. Patient demographic data, possible risk factors, presenting symptoms, radiographic features of aneurysms, size progression, rupture status, and concomitant non-cavernous aneurysm rupture data were manually extracted. RESULTS: 179 patients (mean age at diagnosis 57.2 ± 15.9 years; 86.0% Female) had total 198 cavernous aneurysms. 44.4% of patients had no concomitant non-cavernous aneurysms, 41.9% had 1, and 13.6% had 2. No cavernous aneurysms ruptured during clinical follow-up. 17 non-cavernous concomitant aneurysm ruptured during follow up. 91.5% of cavernous aneurysms showed no change in size, 4.2% increased in size, and 4.2% were initially treated at time of diagnosis. Of the cavernous aneurysms that increased in size, there was a mean increase of 0.97 ± 0.4 mm and 1.1 mm ± 0.7 mm in long and short axis diameter across 5.2 ± 2.3 years. Weakness as a presenting symptom was the only predictor of cavernous aneurysm growth (p-value 0.022). Number of concomitant non-cavernous aneurysms (p-value 0.007) and sub-arachnoid hemorrhage (SAH) as a presenting symptom (p-value <0.0001) were associated with concomitant non-cavernous aneurysmal rupture. CONCLUSIONS: Cavernous ICA aneurysms demonstrate no rupture and limited growth over years of clinical follow-up. No patient radiographic or risk factor suggests increased risk of rupture or other symptomology, thus except for select individuals with concomitant non-cavernous aneurysms and SAH on presentation, there is likely limited clinical benefits in serially following these aneurysms over time.