title: Pipeline Embolization Device for small paraophthalmic artery aneurysms with an emphasis on the anatomical relationship of ophthalmic artery origin and aneurysm.
abstract: OBJECTIVE Contemporary treatment for paraophthalmic artery aneurysms includes flow diversion utilizing the Pipeline Embolization Device (PED). Little is known, however, about the potential implications of the anatomical relationship of the ophthalmic artery (OA) origin and aneurysm, especially in smaller aneurysms. METHODS Four major academic institutions in the United States provided data on small paraophthalmic aneurysms (≤ 7 mm) that were treated with PED between 2009 and 2015. The anatomical relationship of OA origin and aneurysm, radiographic outcomes of aneurysm occlusion, and patency of the OA were assessed using digital subtraction angiography. OA origin was classified as follows: Type 1, OA separate from the aneurysm; Type 2, OA from the aneurysm neck; and Type 3, OA from the aneurysm dome. Clinical outcome was assessed using the modified Rankin Scale, and visual deficits were categorized as transient or permanent. RESULTS The cumulative number of small paraophthalmic aneurysms treated with PED between 2009 and 2015 at the 4 participating institutions was 69 in 52 patients (54.1 ± 13.7 years of age) with a male-to-female ratio of 1:12. The distribution of OA origin was 72.5% for Type 1, 17.4% for Type 2, and 10.1% for Type 3. Radiographic outcome at the last follow-up (median 11.5 months) was available for 54 aneurysms (78.3%) with complete, near-complete, and incomplete occlusion rates of 81.5%, 5.6%, and 12.9%, respectively. Two aneurysms (3%) resulted in transient visual deficits, and no patient experienced a permanent visual deficit. At the last follow-up, the OA was patent in 96.8% of treated aneurysms. Type 3 OA origin was associated with a lower rate of complete aneurysm occlusion (p = 0.0297), demonstrating a trend toward visual deficits (p = 0.0797) and a lower rate of OA patency (p = 0.0783). CONCLUSIONS Pipeline embolization treatment of small paraophthalmic aneurysms is safe and effective. An aneurysm where the OA arises from the aneurysm dome may be associated with lower rates of aneurysm occlusion, OA patency, and higher rates of transient visual deficits.
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Foreman
authors.affiliation: Harvard Medical School.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Chua
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Stapleton
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Aman B
authors.initials: AB
authors.lastname: Patel
authors.affiliation: Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Lucy
authors.initials: L
authors.lastname: He
authors.affiliation: Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Fusco
authors.affiliation: Department of Neurosurgery, Mount Sinai, New York, New York; and.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Winkler
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School.
authors.forename: Apar S
authors.initials: AS
authors.lastname: Patel
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School.
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
mesh_terms: D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000473:pathology; D012189:Retrospective Studies
keywords: ICA = internal carotid artery; OA = ophthalmic artery; PED = Pipeline Embolization Device; Pipeline Embolization Device; SAH = subarachnoid hemorrhage; UCAS = Unruptured Cerebral Aneurysm Study; aneurysm; mRS = modified Rankin Scale; occlusion; ophthalmic artery; outcome; patency; vascular disorders; vision