Introduction and Purpose Flow diversion (FD) is safe and popular method for carotid ophthalmic aneurysms (COA) treatment. Several nuances challenge treatment outcomes. We aim to explore long-term outcomes of ophthalmic aneurysms treated with flow diversion alone, or with adjunctive 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, with or without coil embolization.Four different subtypes of CAO’s were previously described: Type A. Ophthalmic artery (OA) originates directly from the aneurysm fundus, Type 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 on Digital Subtracted Angiography (DSA) or MRA at 1-year follow up. Ophthalmic artery patency at 1-year and treatment-related visual complications were also reviewed.

Results A Total of 123 patients and 129 aneurysms treated at our tertiary center between January 2017 and December 2022 were reviewed. Nine patients (10 aneurysms) were lost to follow up. Clinical and angiographic follow up data of 114 patients (119 aneurysms) were available for analysis. Median age was 54.5. 15 (12%) were men. 71 of 119 aneurysms (59%) were determined Type D, 35 (29%) were determined Type B, 10 (8%) were determined Type A, and 5 (4%) were determined type C. Overall complete occlusion rate was 77%. At 1-year follow up, 11 (15%) Type D aneurysms, 11 (31%) Type B aneurysms, 6 (60%) Type A aneurysms, and none of type C aneurysms had residual filling. The ophthalmic artery was occluded at follow up in 3/10 (30%) of the Type A group, 8/35 (22%) in the Type B group, 0% of type C group, and 3/71 (4%) of type D group. Of patients who underwent FD + coiling (n=34, 28%), 5 (14.7%) showed residual filling at 1-year follow up (2 type D and 3 type B). 18 of the 114 patients (15.7%) had transient and short-lasting disturbing visual symptoms. One patient -type B aneurysm treated with FD and adjunct coiling- developed long-term partial vision loss and optic nerve atrophy. Overall, 14/119 (11.7%) showed OA occlusion at follow up. Three of them had transient visual symptoms, without long-term sequela. 2 patients (1.6%) had a non-disabling strokes, one of them was due to antiplatelets interruption and in-stent thrombosis.

Conclusion In this single center large cohort analysis of carotid ophthalmic aneurysms, flow diversion appears safe and effective. Ophthalmic artery origin from the aneurysm neck or directly from the aneurysm sac is associated with high treatment failure rate. Adjunct coil embolization of high residual risk aneurysms appears safe and may be considered.

Disclosures M. Abdulrazzak: None. A. Pandhi: None. A. Alrohimi: None. R. Achey: None. M. Martucci: None. T. Patterson: None. J. Tsai: None. N. Moore: None. M. Bain: None. M. Hussain: None. G. Toth: None.