Patency of the Ophthalmic Artery After Flow-Diversion Treatment of Paraclinoid Aneurysms

Keywords: aneurysm, endovascular stent, stent, blood flow, outcome

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     In this study we determined the patency rate of the ophthalmic artery after placement of one or more flow diversion devices across the arterial inlet for treatment of proximal internal carotid (ICA) aneurysms, and correlated possible risk factors for ophthalmic artery occlusion.
     We identified 19 consecutive patients (mean age 53.9 years, range 23-74, all females) treated for 20 ICA aneurysms in whom a Pipeline Embolization Device had been placed across the ostium of the ophthalmic artery.
     Potential risk factors for ophthalmic artery occlusion were correlated with patency rate.
     Patients were treated with 1-3 PEDs. In 17 (85%) of 20 treated aneurysms, no changes in the ophthalmic artery flow were noted immediately after placement of the device. Two patients had delayed anterograde filling and one patient had retrograde filling immediately following PED placement. One patient experienced delayed, asymptomatic ICA occlusion; this patient was excluded from analysis at follow up. At follow up the ophthalmic artery remained patent with normal antegrade flow in 13 (68%) of 19 patients, patent but with slow antegrade flow in 2 (11%) patients, and was occluded in 4 (21%) patients. No visual changes or clinical symptoms developed in patients with ophthalmic artery flow compromise. Mean number of PEDs in the patients with occluded ophthalmic arteries or change in flow at angiographic follow-up was 2.4 (SEM 0.2) compared to 1.9 (SEM 0.18) in the patients with no change in ophthalmic artery flow (P=0.09). There was no significant difference between the patients with occluded ophthalmic arteries compared to non-occluded branches based on age, immediate angiographic flow through the ophthalmic branch, status of flow through the aneurysm post-PED placement, location of ophthalmic artery origination or number of PEDs placed across ophthalmic branch inlet.
     This is a retrospective study.
     Approximately one quarter of ophthalmic arteries will undergo proximal thrombosis when covered with flow diversion devices.
     Even though these events were well tolerated clinically, our findings suggest that coverage of branch arteries that have adequate collateral circulation may lead to spontaneous branch occlusion.


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