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009 Preservation of ophthalmic artery arising from aneurysm body during endovascular coil occlusion
  1. E Murphy,
  2. J Pryor
  1. Neurointerventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA

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Introduction and Purpose: Although several treatment strategies have been reported for preserving arteries arising from the dome of an aneurysm, current clinical practice suggests sacrifice of the parent artery is the best option for durable occlusion of the aneurysm. This is the first report of durable unassisted coil occlusion of ophthalmic artery aneurysms with preservation of the parent artery.

Materials and Methods: Between 2006 and 2008, three cases showing the ophthalmic artery originating from the body of the aneurysm were identified by angiography. The medical records were retrospectively reviewed for clinical presentation, angiographic data and outcome.

Results: The index case presented with progressive vision loss in his right eye. Bilateral ophthalmic artery aneurysms were discovered, the left incorporating the artery. He initially underwent surgical clipping of the right paraclinoid aneurysm with complete loss of vision. In an exhaustive effort to preserve vision in the remaining eye, treatment planning involved multiple angiograms and balloon test occlusion, which he failed. The left ophthalmic artery aneurysm was coiled in two stages allowing visual assessment and stabilization of the coil mass before retreatment. The first stage of embolization utilized a dual catheter approach: one microcatheter was used to place a Micrusphere Cerecyte coil to pin the second microcatheter in place and allow for precise placement of a Micrus Ultipaq Cerecyte coil at the apex of the aneurysm dome away from the origin of the ophthalmic artery. Angiography confirmed preservation of flow in the ophthalmic artery prior to detachment of either coil. Healing of coil basket that was created allowed for the stability of the coil mass during placement of additional Micrus Ultipaq Cerecyte coils during stage II embolization. One year follow-up angiogram demonstrates stable aneurysm occlusion with patency of the ophthalmic artery and no change in vision. The dual microcatheter approach was utilized in the second case with successful obliteration of the aneurysm at first attempt with preservation of the ophthalmic artery. The first microcatheter was used to place an ev3 Morpheus coil to trap the second microcatheter. The trapped microcatheter was used to place Micrus Ultipaq Cerecyte coils away from the ophthalmic artery origin. Follow-up at 7 months demonstrated a stable coil mass and patent ophthalmic artery. The third case initially underwent craniotomy and partial clipping of the right ophthalmic artery aneurysm in order to preserve the vessel; however, femoral cerebral angiography demonstrated aneurysm growth after 5 years. She received stent remodeling and coil embolization with preservation of her ophthalmic artery. Initially, an ev3 Morpheus coil was placed. Final run showed satisfactory stent and coil placement without compromise of the ophthalmic artery.

Conclusion: Our results effectively demonstrate the possible and plausible evolution of the current treatment paradigm for these ophthalmic artery aneurysm cases. Successful and durable endovascular treatment of these aneurysms can be achieved without vessel sacrifice. Successful results can be obtained through endovascular treatment alone or with a multidisciplinary approach as a retreatment option in the case of residual aneurysm or regrowth.

Competing interests: JP, Micrus Endovascular, ev3.