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Patency of the ophthalmic artery after flow diversion treatment of paraclinoid aneurysms

Clinical article

Ross C. Puffer, David F. Kallmes, Harry J. Cloft, and Giuseppe Lanzino

Object

In this study the authors determined the patency rate of the ophthalmic artery (OphA) after placement of 1 or more flow diversion devices across the arterial inlet for treatment of proximal internal carotid artery (ICA) aneurysms, and correlated possible risk factors for OphA occlusion.

Methods

Nineteen consecutive patients were identified (mean age 53.9 years, range 23–74 years, all female) who were treated for 20 ICA aneurysms. In all patients a Pipeline Embolization Device (PED) was placed across the ostium of the OphA while treating the target aneurysm. Flow through the OphA after PED placement was determined by immediate angiography as well as follow-up angiograms (mean 8.7 months), compared with the baseline study. Potential risk factors for OphA occlusion, including age, immediate angiographic flow through the ophthalmic branch, status of flow within the aneurysm after placement of PEDs, whether the ophthalmic branch originated from the aneurysm dome, and number of PEDs placed across the ophthalmic branch inlet were correlated with patency rate.

Results

Patients were treated with 1–3 PEDs (3 aneurysms treated with placement of 1 PED, 12 with 2 PEDs, and 5 with 3 PEDs). In 17 (85%) of 20 treated aneurysms, no changes in the OphA flow were noted immediately after placement of the device. Two (10%) of 20 patients had delayed antegrade filling immediately following PED placement and 1 patient (5%) had retrograde flow from collaterals to the OphA immediately after placement of the device. One patient (5%) experienced delayed asymptomatic ICA occlusion; this patient was excluded from analysis at follow-up. At follow-up the OphA remained patent with normal antegrade flow in 13 (68%) of 19 patients, patent but with slow antegrade flow in 2 patients (11%), and was occluded in 4 patients (21%). No visual changes or clinical symptoms developed in patients with OphA flow compromise. The mean number of PEDs in the patients with occluded OphAs or change in flow at angiographic follow-up was 2.4 (SEM 0.2) compared with 1.9 (SEM 0.18) in the patients with no change in OphA flow (p = 0.09). There was no significant difference between the patients with occluded OphAs compared with nonoccluded branches based on patient age, immediate angiographic flow through the ophthalmic branch, status of flow through the aneurysm after placement of PEDs, whether the ophthalmic branch originated from the aneurysm dome, or number of PEDs placed across the ophthalmic branch inlet.

Conclusions

Approximately one-quarter of OphAs 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 occlusion of those branches.

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Efficacy and safety of flow diverter combined with coil embolization and evidence-based antithrombotic regimen in the treatment of ruptured aneurysms

Zhen Chen, Wentao Gong, Wei You, Haowen Xu, Dongdong Li, Chao Liu, Youxiang Li, and Sheng Guan

(4.9%)  Postop OKM grade, no. (%)   A 3 (7.3%)   B 23 (56.1%)   C 9 (22.0%)   D 6 (14.6%)  Drainage of CSF, no. (%)   Lumbar puncture 19 (46.3%)   Continuous lumbar drainage 4 (9.8%)   EVD 0 FU outcome  Patients w/ FU, no. (%) 25 (61.0%)  Time to FD placement in mos, median (IQR) 8.0 (6.0–15.5)  FU OKM grade, no. (%)   A 0   B 2 (8.0%)   C 3 (12.0%)   D 20 (80.0%) FU = follow-up; PED = Pipeline embolization device

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FRED Jr stent for acute flow diversion in ruptured cerebral aneurysms arising from small-caliber vessels: a clinical case series

Omer Doron, Rachel McLellan, Justin E. Vranic, Robert W. Regenhardt, Christopher J. Stapleton, and Aman B. Patel

; MCA = middle cerebral artery; mFS = modified Fisher score; Mgmt = management; NA = not applicable; PBD = postbleed day; PED = Pipeline embolization device; pt = patient; SDH = subdural hematoma; Tx = treatment. * Intra-arterial verapamil. No technical difficulties were encountered in the process of FRED Jr deployment. In 3 patients previous attempts were made to coil the aneurysm, which were not successful, and it was decided to proceed with a flow diverter. Aneurysm and device characteristics are further detailed in Table 2 . TABLE 2. Procedure, device

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Trends in the size of treated unruptured intracranial aneurysms over 35 years

MirHojjat Khorasanizadeh, Samuel D. Pettersson, Benton Maglinger, Alfonso Garcia, S. Jennifer Wang, and Christopher S. Ogilvy

= Pipeline embolization device; SAC = stent-assisted coiling. Figure is available in color online only. Another factor that has possibly contributed to the treatment of smaller UIAs over time is the growing understanding of the risks of leaving these lesions untreated. While individual sUIAs have been shown to carry a very small annual risk of rupture in natural history studies, 2 , 3 more recent evidence has shown that collectively sUIAs are responsible for more than half of aSAHs, 4 – 6 and this proportion has been increasing with time. 6 , 35 This poses a

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Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery: systematic review of literature and meta-analysis on safety and efficacy

Sumedh S. Shah, Zachary C. Gersey, Mohamed Nuh, Hesham T. Ghonim, Mohamed Samy Elhammady, and Eric C. Peterson

demographics per endovascular and surgical treatment arms can be found in Tables 3 and 4 , respectively. TABLE 2. Characteristics of treatments documented in this study Endovascular (22 papers) Surgical (18 papers) Treatment No. Treatment No. FD stent 12 Clip 63 PED 7 Wrap 2 Stent (multiple) 11 Bypass 8 Coil 13 Suture 1 Stent + coil 74 Clip + wrap 15 Endovascular trapping 1 Clip + bypass 4 Other/unspecified 4 Clip + wrap + suture 1 Surgical trapping 22 Trapping + bypass 23 Total 122 139 Percentage 46.7% 53.2% FD = flow-diverting; PED = Pipeline embolization device. TABLE