Flow Diversion versus Standard Endovascular Techniques for the Treatment of Unruptured Carotid-Ophthalmic Aneurysms.
OBJECTIVE
Over the past few years, flow diversion has been increasingly adopted for the treatment of intracranial aneurysms, especially in the paraclinoid and paraophthalmic carotid segment. We compared clinical and angiographic outcomes and complication rates in 2 groups of patients with unruptured carotid-ophthalmic aneurysms treated for 7 years by either standard coil-based techniques or flow diversion.


METHODS
From February 2006 to December 2013, 162 unruptured carotid-ophthalmic aneurysms were treated endovascularly in 138 patients. Sixty-seven aneurysms were treated by coil-based techniques in 61 patients. Flow diverters were deployed in 95 unruptured aneurysms (77 patients), with additional coiling in 27 patients. Complication rates, clinical outcome, and immediate and long-term angiographic results were retrospectively analyzed.


RESULTS
No procedure-related deaths occurred. Four procedure-related thromboembolic events (6.6%) leading to permanent morbidity in 1 case (1.6%) occurred in the coiling group. Neurologic complications were observed in 6 patients (7.8%) in the flow-diversion group, resulting in 3.9% permanent morbidity. No statistically significant difference was found between complication (P = .9) and morbidity rates (P = .6). In the coiling group (median follow-up, 31.5 ± 24.5 months), recanalization occurred at 1 year in 23/50 (54%) aneurysms and 27/55 aneurysms (50.9%) at the latest follow-up, leading to retreatment in 6 patients (9%). In the flow-diversion group (mean follow-up, 13.5 ± 10.8 months), 85.3% (35/41) of all aneurysms were occluded after 12 months, and 74.6% (50/67) on latest follow-up. The retreatment rate was 2.1%. Occlusion rates between the 2 groups differed significantly at 12 months (P < .001) and at the latest follow-up (P < .005).


CONCLUSIONS
Our retrospective analysis shows better long-term occlusion of carotid-ophthalmic aneurysms after use of flow diverters compared with standard coil-based techniques, without significant differences in permanent morbidity.
From the Department of Neuroradiology (F.D.M., F.C., H.R., J.C., N.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris, France federico.dimaria@gmail.com.
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Di Maria
Department of Neuroradiology (S.P., B.B., R.B., H.R., M.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
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S
Pistocchi
From the Department of Neuroradiology (F.D.M., F.C., H.R., J.C., N.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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http://orcid.org/0000-0002-6442-8239
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Clarençon
Department of Neuroradiology (S.P., B.B., R.B., H.R., M.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
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B
Bartolini
Department of Neuroradiology (S.P., B.B., R.B., H.R., M.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
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R
Blanc
Department of Neuroradiology (A.B.), Centre Hospitalier J. Minjoz, Besançon, France.
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http://orcid.org/0000-0002-3185-0740
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Biondi
From the Department of Neuroradiology (F.D.M., F.C., H.R., J.C., N.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris, France Department of Neuroradiology (S.P., B.B., R.B., H.R., M.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
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H
Redjem
From the Department of Neuroradiology (F.D.M., F.C., H.R., J.C., N.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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J
Chiras
From the Department of Neuroradiology (F.D.M., F.C., H.R., J.C., N.S.), Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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N
Sourour
Department of Neuroradiology (S.P., B.B., R.B., H.R., M.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
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M
Piotin
D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome