Long-term visual outcome in patients treated by flow diversion for carotid-ophthalmic aneurysms

Touzé, Romain; Shotar, Eimad; Gabrieli, Joseph; Drir, Mehdi; Mathon, Bertrand; Sourour, Nader‐Antoine; Clarençon, Frédéric

doi:10.1136/neurintsurg-2017-013684

Cited by 18 publications

(28 citation statements)

References 31 publications

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“…In the present study, the reduced rate of corrective interventions (9% vs 20%) can be explained by the more accurate sizing of the device, improving the stent wall apposition, and reducing the possibility of an inadequate proximal landing zone opening. Accordingly, we observed a lower rate of balloon angioplasty in the Sim&Size group, with rates in the two cohorts (with and without simulation) in general aligned or lower than previously reported 8 9. In addition, virtual simulation lowered the need either to discard the stent for incorrect dimensions, or to deploy a second device because of the insufficient neck coverage, or the termination of the proximal landing zone in a curve.…”

Section: Discussionsupporting

confidence: 56%

“…A recent meta-analysis showed an incidence of 3% of new visual symptoms after deployment of flow diverters covering the ophthalmic artery 18. However, when a formal ophthalmologist evaluation is undertaken, newly developed visual abnormalities, though mostly asymptomatic, rise up to 40% 19 20. Another recent meta-analysis showed a symptomatic rate of 1% for coverage of the anterior choroidal artery 21.…”

Section: Discussionmentioning

confidence: 99%

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Virtual simulation with Sim&Size software for Pipeline Flex Embolization: evaluation of the technical and clinical impact

Piergallini

Conte

Dargazanli

et al. 2020

J NeuroIntervent Surg

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IntroductionDuring flow diversion, the choice of the length, diameter, and location of the deployed stent are critical for the success of the procedure. Sim&Size software, based on the three-dimensional rotational angiography (3D-RA) acquisition, simulates the release of the stent, suggesting optimal sizing, and displaying the degree of the wall apposition.ObjectiveTo demonstrate technical and clinical impacts of the Sim&Size simulation during treatment with the Pipeline Flex Embolization Device.MethodsConsecutive patients who underwent aneurysm embolization with Pipeline at our department were retrospectively enrolled (January 2015–December 2017) and divided into two groups: treated with and without simulation. Through univariate and multivariate models, we evaluated: (1) rate of corrective intervention for non-optimal stent placement, (2) duration of intervention, (3) radiation dose, and (4) stent length.Results189 patients, 95 (50.2%) without and 94 (49.7%) with software assistance were analyzed. Age, sex, comorbidities, aneurysm characteristics, and operator’s experience were comparable among the two groups. Procedures performed with the software had a lower rate of corrective intervention (9% vs 20%, p=0.036), a shorter intervention duration (46 min vs 52 min, p=0.002), a lower median radiation dose (1150 mGy vs 1558 mGy, p<0.001), and a shorter stent length (14 mm vs 16 mm, p<0.001).ConclusionsIn our experience, the use of the virtual simulation during Pipeline treatment significantly reduced the need for corrective intervention, the procedural time, the radiation dose, and the length of the stent.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Virtual simulation with Sim&Size software for Pipeline Flex Embolization: evaluation of the technical and clinical impact

Piergallini

Conte

Dargazanli

et al. 2020

J NeuroIntervent Surg

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“…At present, no study has illustrated that changes in the ophthalmic artery are associated with new visual symptoms in patients. Touzé et al [24] believed that the ophthalmic artery has abundant external carotid anastomotic branch compensation, and when the origin of the ophthalmic artery is covered by FDD, the ophthalmic artery and the external carotid anastomotic branch need to achieve a new pressure balance. During establishment of this process, if retinal perfusion pressure is reduced, symptoms of amaurosis fugax may be apparent.…”

Section: Discussionmentioning

confidence: 99%

“…During establishment of this process, if retinal perfusion pressure is reduced, symptoms of amaurosis fugax may be apparent. For Type B aneurysms, dislodged microthrombi also cause emboli in retinal branch arteries after intra-aneurysmal thrombosis, resulting in visual eld defects [19,24].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Peri-Ophthalmic Aneurysm Incomplete Occlusion and Visual Symptoms After Treatment with a Pipeline Embolization Device: A Multi-Center Cohort Study

Xu¹,

Wu²,

Sun³

et al. 2021

Preprint

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Objective: Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes.Methods: We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1,171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid–ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: Type A, OA originating separate from the aneurysm; Type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment. Results: The median follow-up time was 6.8 months (range, 5.3–20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that Type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.951, 95% confidence interval [CI] 1.904-12.875, p = 0.001). Visual symptoms at final follow up correlated with preoperative visual symptoms (OR 16.005, 95% CI 2.505-102.273, p = 0.003).Conclusions: Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.

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“…Retinal artery occlusion (RAO) is a specific complication of this treatment, and its frequency following endovascular coiling is in the range of 4-10%. [1][2][3][4][5][6][7][8][9][10] However, few detailed reports have been published on ICA-OphA AN treatment that analyzed the correlation between the flow in the ophthalmic artery (OphA) after embolization and symptoms, their time of appearance, and prognosis of visual complications. This study assessed the angiographic and clinical outcomes of consecutive patients who presented for initial treatment of an ICA-OphA AN via an endovascular approach at our institution.…”

Section: Introductionmentioning

confidence: 99%

Visual complications after coil embolization of internal carotid artery aneurysms at the ophthalmic segment

et al. 2021

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Background Coil embolization of aneurysms of the ophthalmic segment of the internal carotid artery (ICA-OphA ANs) has potential risks of visual complications. We analyzed this risk and focused on the relationship of the ophthalmic artery (OphA) origin with the aneurysm neck. Methods From January 2003 to April 2018, 179 unruptured ICA-OphA ANs were treated with endovascular surgery in our institution. Two ruptured and four aneurysms with missing data were excluded. Finally, 173 unruptured aneurysms were included in this study. The aneurysms were classified into three groups according to the location of the OphA origin: Separate, Shared, and Dome type. We retrospectively assessed visual complications based on the relationship between types of aneurysm and postoperative angiographic findings for the OphA. Results Visual deficits remained permanent in eleven cases (6.4%). In the Dome type, visual complications were significantly more frequent compared to the Separate type. Change in the OphA flow was significantly associated with a higher complication rate of 2.9%, but patients with changed OphA flow had a significant rate of 7.5% ( p = 0.020). We found no significant difference in the incidence of visual complications concerning the use of perioperative antithrombotic therapy. Conclusions The location of OphA origin regarding the aneurysmal neck and postoperative OphA flow were significantly correlated with the visual outcome after coil embolization for ICA-OphA ANs. Post-procedural flow in the OphA was an important factor affecting the rate of ischemic retinal complications. Retinal embolic events occurred with preserved flow in the OphA, albeit at a lower rate.

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Long-term visual outcome in patients treated by flow diversion for carotid-ophthalmic aneurysms

Cited by 18 publications

References 31 publications

Virtual simulation with Sim&Size software for Pipeline Flex Embolization: evaluation of the technical and clinical impact

Virtual simulation with Sim&Size software for Pipeline Flex Embolization: evaluation of the technical and clinical impact

Predictors of Peri-Ophthalmic Aneurysm Incomplete Occlusion and Visual Symptoms After Treatment with a Pipeline Embolization Device: A Multi-Center Cohort Study

Visual complications after coil embolization of internal carotid artery aneurysms at the ophthalmic segment

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