Introduction and Purpose Flow diversion (FD) is a common and effective method for carotid-ophthalmic aneurysms (COA) treatment. The origin of the ophthalmic artery (OA) in relation to the aneurysm sac can determine recurrence and treatment-related complications. We aim to study outcomes of COA’s treated with FD alone, or in combination with coil embolization, based on the origin of the ophthalmic artery in-relation to the aneurysm sac.

Methods Retrospective analysis of prospectively collected tertiary center data of patients with carotid ophthalmic aneurysms treated with flow diversion stents, plus or minus coil embolization. Based on the ophthalmic artery origin, four types of carotid ophthalmic aneurysms were previously described and implemented in this study. Type A. OA originates directly from the aneurysm fundus, B. OA originates from the aneurysm neck, C. OA originates from the inner curve of the carotid siphon, D. OA is separate from the aneurysm. Primary assessed outcome was aneurysm occlusion at 1-year, determined by Digital Subtraction Angiography (DSA) or MRA. Ophthalmic artery patency at 1-year and treatment-related visual complications were also collected from chart review.

Results A Total of 51 patients treated at our tertiary center between January 2017 and August 2019 were reviewed. 4 patients were lost to follow up. Clinical and angiographic data of 50 COAs treated with either FD alone or the combination of FD and coil embolization were available to review. Median age was 55. 7 (14%) of patients were men. 28 of 50 aneurysms (56%) were determined Type D, 18 of 50 (36%) were determined Type B, 4 of 50 (8%) were determined Type A, and no Type C aneurysm was identified. Overall complete occlusion rate was 78%. 4 (14%) of Type D aneurysms had residual filling, 6 (33%) of Type B aneurysms had residual filling, and 1 (25%) of Type A aneurysms had residual filling. The ophthalmic artery was occluded at follow up in all but one patient in the Type A group (75%), 2 (7.1%) in the Type D group, and 5 (27%) in the Type B group. Of patients who underwent FD + coil embolization (n=15, 30%), only one Type B aneurysm showed residual filling at 1-year follow up. 12 of the 47 patients (25%) had transient and short-lasting disturbing visual symptoms, but none had long-term complications. 4 of the 12 patients with visual symptoms showed OA occlusion at follow up. 1 patient (2%) had a non-disabling stroke due to antiplatelets interruption and in-stent thrombosis.

Conclusion Flow diversion is safe and effective for carotid ophthalmic aneurysms treatment. Adjunct coil embolization and ophthalmic artery origin in relation to the aneurysm sac are independent factors that can influence treatment result, and should be considered when planning treatment.

Disclosures M. Abdulrazzak: None. A. Alrohimi: None. A. Pandhi: None. T. Patterson: None. N. Moore: None. J. Tsai: None. M. Bain: None. M. Hussain: None. T. Masaryk: None. P. Rassmusen: None. G. Toth: None.