Abstract
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.
Highlights
We reported on a large series of patients with carotid-ophthalmic artery aneurysms, focusing on periprocedural complications as well as mid- and long-term angiographic and clinical outcomes, including visual outcomes
46 carotidophthalmic aneurysms were treated in 44 patients, of whom 2 were treated for mirror aneurysms
Our study of 44 patients with 46 ophthalmic segment aneurysms treated with flow diversion demonstrated high rates of angiographic occlusion with low rates of clinical adverse events, which included worsening of visual function
Summary
Patient Population Consecutive prospectively collected data on 175 patients evaluated for treatment with PED or, more recently, with Surpass flow diversion were retrospectively analyzed. Information prospectively collected as part of an internal quality assurance project included patient demographics; aneurysm location, classification, and size; symptomatic or asymptomatic status; type and number of devices used; adjunctive coiling; periprocedural technical and clinical complications; length of hospital stay; and angiographic and clinical follow-up. Procedure Details Patients undergoing placement of the PED were premedicated with aspirin and clopidogrel for a minimum of 5 days, and the device was placed while the patient was under full anticoagulation (activated clotting time of 250 –300 seconds). No patient underwent testing for clopidogrel response except for the lone patient treated with the Surpass device who underwent the genetic test for CYP219 as part of the prospective study under which they were treated. The lone patient treated with the Surpass device was treated in accordance with the Surpass Study Group protocol, which was functionally similar to the operative technique for placement of the PED. All analyses were performed by using JMP 10.0 (SAS Institute, Cary, North Carolina)
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