title: Endovascular treatment of ophthalmic artery aneurysms: assessing balloon test occlusion and preservation of vision in coil embolization.
abstract: OBJECTIVE
  ICA-ophthalmic artery aneurysms have unique configurations corresponding to relative risks of ophthalmologic morbidities. Presented herein are clinical and radiologic outcomes of coil embolization in ophthalmic artery aneurysms.
  
  
  METHODS
  From January 2003 to September 2013, endovascular coiling was performed in 43 consecutive patients with ophthalmic artery aneurysms, each classified by the degree to which the ophthalmic artery was incorporated by the aneurysm and the contiguity between the ophthalmic artery entry and parent ICA. Clinical and radiologic outcomes of this approach were investigated, including the technical aspects of treatment and the efficacy of balloon test occlusion.
  
  
  RESULTS
  Among 14 patients (32.6%, all ophthalmic artery types) undergoing balloon test occlusion before endovascular coiling, patent collaterals between the external carotid artery and ophthalmic artery were demonstrated in 12 (85.7%) and complete compromise of the ophthalmic artery (without affecting vision) occurred in 4 patients during coiling. Steam-shaped S-configured (67.9%) or straight microcatheters (17.8%) facilitated aneurysm selection in most of the superiorly directed ophthalmic artery aneurysms (n = 28), and steam-shaped pigtail microcatheters (85.7%) were useful in medially directed aneurysms (n = 14). Balloon protection (n = 22) was generally used to facilitate coiling, or a stent (n = 9) was alternatively deployed. Satisfactory aneurysmal occlusion was achieved through coil embolization in 37 lesions (86.1%). During follow-up of 35 patients (mean interval, 12.9 ± 9.4 months), only 1 instance (2.9%) of major recanalization was observed.
  
  
  CONCLUSIONS
  If one tailors technical strategies, ophthalmic artery aneurysms are amenable to safe and effective endovascular coil embolization, which tends to be stable in follow-up. Balloon test occlusion may be helpful in devising treatment strategies to preserve vision when coiling ophthalmic artery aneurysms (especially those incorporating an ophthalmic artery origin) is done.
authors: From the Department of Neurosurgery (J.H.A.), Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
authors: J H
authors: JH
authors: Ahn
authors: Departments of Radiology (Y.D.C., M.H.H.) aronnn@naver.com.
authors: Y D
authors: YD
authors: Cho
authors: Neurosurgery (H.-S.K., J.E.K., W.-S.C., M.H.H.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: H-S
authors: HS
authors: Kang
authors: Neurosurgery (H.-S.K., J.E.K., W.-S.C., M.H.H.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: J E
authors: JE
authors: Kim
authors: Neurosurgery (H.-S.K., J.E.K., W.-S.C., M.H.H.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: W-S
authors: WS
authors: Cho
authors: Department of Radiology (S.C.J.), Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
authors: S C
authors: SC
authors: Jung
authors: Department of Neurology (C.H.K.), Stroke Center, Myongji Hospital, Goyang, Korea.
authors: C H
authors: CH
authors: Kim
authors: Departments of Radiology (Y.D.C., M.H.H.) Neurosurgery (H.-S.K., J.E.K., W.-S.C., M.H.H.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: M H
authors: MH
authors: Han
mesh_terms: D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000601:surgery*; D016896:Treatment Outcome