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Original research
Long-term visual outcome in patients treated by flow diversion for carotid-ophthalmic aneurysms
  1. Romain Touzé1,2,
  2. Valérie Touitou2,3,
  3. Eimad Shotar1,3,
  4. Joseph Gabrieli4,
  5. Mehdi Drir5,
  6. Bertrand Mathon3,6,7,
  7. Nader-Antoine Sourour1,
  8. Frédéric Clarençon1,3
  1. 1Departement of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
  2. 2Departement of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
  3. 3Paris VI University, Pierre et Marie Curie, Paris, France
  4. 4Departement of Interventional Neuroradiology, Padova University Hospital, Padova, Italy
  5. 5Departement of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France
  6. 6Departement of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
  7. 7Paris VI University, Pierre et Marie Curie, Paris, France
  1. Correspondence to Dr Frédéric Clarençon, Departement of Neuroradiology, Pitié-Salpêtrière Hospital, Paris 75013, France; fredclare5{at}gmail.com

Abstract

Background Flow-diverter stents (FDSs) are an upgrade in the treatment of intracranial aneurysms. However, complications concerning covered branches have been reported, especially the ophthalmic artery (OA). The purpose of our study was to evaluate the long-term ophthalmic complication rate of carotid-ophthalmic aneurysms (COA) without visual pathways compression, treated by a FDS covering the OA by performing an exhaustive ophthalmic examination.

Material and methods Retrospective analysis of a single-center database screening the patients treated from October 2009 to April 2015 for an intracranial aneurysm with a FDS. The patients treated for a non-compressive COA with coverage of the OA by the device were studied (n=30). Among these patients, 15 (50%) were excluded. The remaining 15 patients underwent a systematic and extensive ophthalmic examination at least 2 years after the stent placement by two ophthalmologists.

Results Fifteen patients with 16 COAs treated with a FDS were included. Mean follow-up was 4.1±2 years. Six patients (40%), presented ophthalmic complications, including three fugax amauroses (18.8%) and four significant visual field defects (25%). After comparing each eye’s visual field’s patients, we observed a significant difference between the eye on the FDS side compared with the contralateral eye, with a mean deviation of −1.58 dB versus −0.67 dB respectively (P=0.003). Visual acuity was preserved in all patients.

Conclusion Patients treated by FDS for COA have a good long-term clinical ophthalmic outcome. However, extensive ophthalmic examination shows a high percentage of minor ophthalmic modifications. Interventional neuroradiologists should be aware of these possible complications when choosing to treat these aneurysms with FDS.

  • flow diverter
  • orbit
  • complication
  • blood flow
  • aneurysm

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Footnotes

  • Contributors All authors made substantial contributions to conception and design, analysis, and interpretation of data; drafted or critically revised the article; and gave final approval of the version to be published.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests FC—UNRELATED: Payment for Lectures including Service on Speakers Bureaus: Medtronic, Guerbet, Balt Extrusion; Other: Codman Neurovascular, Comments: Study Core Lab. N-AS—RELATED: Consulting Fee or Honorarium: Medtronic, Balt Extrusion, Microvention; UNRELATED: Stock/Stock Options: Medina.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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