title: Cavernous carotid aneurysms in the era of flow diversion: a need to revisit treatment paradigms.
abstract: OBJECTIVE
  Recent techniques of endoluminal reconstruction with flow-diverting stents have not been incorporated into treatment algorithms for cavernous carotid aneurysms. This study examines the authors' institutional experience and a systematic review of the literature for outcomes and complications using the Pipeline Embolization Device in unruptured cavernous carotid aneurysms.
  
  
  METHODS
  A retrospective search for cavernous carotid aneurysms from a prospectively collected data base of aneurysms treated with the Pipeline Embolization Device at our institution was performed. Baseline demographic, clinical, and laboratory values; intrainterventional data; and data at all follow-up visits were collected. A systematic review of the literature for complication data was performed with inquiries sent when clarification of data was needed.
  
  
  RESULTS
  Forty-three cavernous carotid aneurysms were included in the study. Our mean radiographic follow-up was 2.05 years. On last follow-up, 88.4% of the aneurysms treated had complete or near-complete occlusion. Aneurysm complete or near-complete occlusion rates at 6 months, 12 months, and 36 months were 81.4%, 89.7%, and 100%, respectively. Of patients with neuro-ophthalmologic deficits on presentation, 84.2% had improvement in their visual symptoms. Overall, we had a 0% mortality rate and a 2.3% major neurologic complication rate. Our systematic review of the literature yielded 227 cavernous carotid aneurysms treated with the Pipeline Embolization Device with mortality and morbidity rates of 0.4% and 3.1%, respectively.
  
  
  CONCLUSIONS
  Endoluminal reconstruction with flow diversion for large unruptured cavernous carotid aneurysms can yield high efficacy with low complications. Further long-term data will be helpful in assessing the durability of the cure; however, we advocate a revisiting of current management paradigms for cavernous carotid aneurysms.
authors.affiliation: From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.).
authors.forename: O
authors.initials: O
authors.lastname: Tanweer
authors.affiliation: Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.).
authors.forename: E
authors.initials: E
authors.lastname: Raz
authors.affiliation: From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.).
authors.forename: A
authors.initials: A
authors.lastname: Brunswick
authors.affiliation: From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.) Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.).
authors.forename: D
authors.initials: D
authors.lastname: Zumofen
authors.affiliation: Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.).
authors.forename: M
authors.initials: M
authors.lastname: Shapiro
authors.affiliation: Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.).
authors.forename: H A
authors.initials: HA
authors.lastname: Riina
authors.affiliation: Neurology (M.F., T.B., P.K.N.), New York University School of Medicine, New York, New York.
authors.forename: M
authors.initials: M
authors.lastname: Fouladvand
authors.affiliation: Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.) Neurology (M.F., T.B., P.K.N.), New York University School of Medicine, New York, New York.
authors.forename: T
authors.initials: T
authors.lastname: Becske
authors.affiliation: From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.) Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.) Neurology (M.F., T.B., P.K.N.), New York University School of Medicine, New York, New York. peter.nelson@nyumc.org.
authors.forename: P K
authors.initials: PK
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D002340:Carotid Artery Diseases / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies