Abstract
Introduction:
Flow diverters have emerged as an important tool in the management of intracranial aneurysms. This study aims to assess the visual outcomes, the obliteration rate and the need for retreatment of ophthalmic segment aneurysms (OSA) treated by the pipeline embolization device (PED). The study also systematically assesses a crucial issue with the use of flow diverters namely the patency of the ophthalmic artery (OA).
Methods:
Forty-one patients harboring 44 OSA treated by flow-diversion and 95 patients with internal carotid artery (ICA) aneurysms who had one or more PEDs covering the OA and in whom angiographic follow-up was available were identified. Complication rates, the need for re-treatment, aneurysm occlusion rates, the evolution of visual symptoms, and the evolution of headache/retro-orbital pain were registered. The patency of the OA at follow-up was systematically evaluated by two investigators.
Results:
The technical success rate was 100% for OSA. The complication rate was 2.27% and the mortality rate was 0%. At final angiographic follow-up, 77.27% of patients with OSA had complete occlusion, 6.81% had near-complete occlusion, and 15.90% had incomplete occlusion. Of symptomatic OSA, complete resolution or significant improvement was noted in 72.72%, while worsening of symptoms occurred in 4.54%. Also, 22% of patients had no significant changes in their symptoms. Of 95 patients with ICA aneurysms, the OA was covered by 1 PED in 81 patients (85%) and by 2 PEDs in 14 patients (15%). Mean angiographic follow-up time was 7.5 months. At the latest follow-up, the OA remained patient in 85 patients (89%), showed diminished flow in 4 patients (4%), and was occluded in 6 patients (7%). Only one patient (1%) had clinical symptoms related to OA occlusion. In multivariable analysis, younger age, larger aneurysm size and coverage by more than 1 device predicted OA occlusion.
Conclusion:
Flow-diversion appears to be an appealing option for OSA. The PED also preserves the patency of the OA in most cases. The occlusion of the OA in the few cases where it occurs is usually a clinically irrelevant event. Minimizing the number of PEDs across the OA is a crucial factor to preserve its patency.