Abstract
Aneurysms of the cavernous segment of the ICA are difficult to treat with standard endovascular techniques, and ICA sacrifice achieves a high rate of occlusion but carries an elevated level of surgical complications and risk of de novo aneurysm formation. We report rates of occlusion and treatment-related data in 44 patients with cavernous sinus aneurysms treated with flow diversion. Patients with cavernous segment aneurysms treated with flow diversion were selected from a prospectively maintained data base of patients from 2009 to the present. Demographic information, treatment indications, number/type of flow diverters placed, outcome, complications (technical or clinical), and clinical/imaging follow-up data were analyzed. We identified 44 patients (37 females, 7 males) who had a flow diverter placed for treatment of a cavernous ICA aneurysm (mean age, 57.2; mean aneurysm size, 20.9 mm). The mean number of devices placed per patient was 2.2. At final angiographic follow-up (mean, 10.9 months), 71% had complete occlusion, and of those with incomplete occlusion, 40% had minimal remnants (<3 mm). In symptomatic patients, complete resolution or significant improvement in symptoms was noted in 90% at follow-up. Technical complications (which included, among others, vessel perforation in 4 patients, groin hematoma in 2, and asymptomatic carotid occlusion in 1) occurred in approximately 36% of patients but did not result in any clinical sequelae immediately or at follow-up. Our series of flow-diversion treatments achieved markedly greater rates of complete occlusion than coiling, with a safety profile that compares favorably with that of carotid sacrifice.
Highlights
BACKGROUND AND PURPOSEAneurysms of the cavernous segment of the ICA are difficult to treat with standard endovascular techniques, and ICA sacrifice achieves a high rate of occlusion but carries an elevated level of surgical complications and risk of de novo aneurysm formation
We identified 44 patients (37 females, 7 males) who had a flow diverter placed for treatment of a cavernous ICA aneurysm
Aneurysms originating from the cavernous segment of the internal carotid artery are thought to have a more benign natural history than intracranial aneurysms in other vascular territories, with a substantially lower risk of rupture.[1,2,3]
Summary
Patients with cavernous segment aneurysms treated with flow diversion were selected from a prospectively maintained data base of patients from 2009 to the present. Demographic information, treatment indications, number/type of flow diverters placed, outcome, complications (technical or clinical), and clinical/imaging follow-up data were analyzed. From prospectively maintained data bases of patients treated with flow diverters, those who underwent treatment for a cavernous ICA aneurysm from 2009 to the present were selected and retrospectively reviewed. Some of the patients reported were enrolled in the Pipeline for Uncoilable or Failed Aneurysms Study[9] or were reported as part of a large series on flow diversion.[10] Demographic information, indication for treatment, type and number of flow diverters placed, treatment outcome, complications (technical or clinical, with 1-sided confidence intervals), and clinical/imaging follow-up data were collected and analyzed. The shorter duration of the dual antiplatelet therapy is related to our belief that if flow diverters are adequately sized, they oppose better against the vessel wall; after an initial period of potential higher thrombogenicity, the risk of late thromboembolic complications when these devices are used in the proximal ICA is very low and is outweighed by the risk of continuing dual antiplatelet therapy akin to a proximal carotid stent.[11]
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