Introduction Intra-saccular flow disruptors (ISFD) have not yet been routinely used for internal carotid artery (ICA) para-ophthalmic aneurysms. However, flow diverter stents (FDS) have been considered the first-line treatment of these aneurysms with optimal occlusion rates.

Aim of Study This single-center study aims to assess the safety and efficacy of ISFD compared to FDS for para-ophthalmic aneurysm treatment.

Methods We retrospectively reviewed consecutive patients with para-ophthalmic aneurysms treated with either ISFD or FDS at our institution from January 2011 to March 2023. We collected demographics, technical success, complication rates, and angiographic outcomes.

Results We identified 46 patients (median age: 50.4) with 51 unruptured saccular ICA para-ophthalmic aneurysms. The mean aneurysm size was 6.2 mm, including 55% of wide-necked lesions (neck size >4mm). The treatments included WEB or CONTOUR devices in 17 cases and FDS in 34 cases. At the latest follow-up (FU) available, aneurysms treated by FDS demonstrated adequate occlusion (defined as complete occlusion or presence of a neck remnant) in 92.9% (mean FU time 59 months). Those treated with ISFD showed comparable results, with 94.1% (p=0.8) achieving adequate occlusion (mean FU 26 months). Thromboembolic events occurred in 5.8% of patients in each group. No mortality was observed, one patient in the FDS group experienced permanent morbidity following parenchymal hematoma (hemiparesis and aphasia).

Conclusion ISFD offers a safe and effective alternative for FDS in para-ophthalmic aneurysm treatment. Its benefits include reduced peri-operative anti-platelet administration with potential application in emergency settings.