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Original research
Flow diversion for internal carotid artery aneurysms with compressive neuro-ophthalmologic symptoms: clinical and anatomical results in an international multicenter study
  1. Gregoire Boulouis1,
  2. Sebastien Soize2,
  3. Volker Maus3,
  4. Sebastian Fischer3,
  5. Donald Lobsien4,
  6. Joachim Klisch4,
  7. Hanna Styczen5,
  8. Cornelius Deuschl5,
  9. Nuran Abdullayev6,
  10. Christoph Kabbasch6,
  11. Daniel Kaiser7,8,
  12. Ala Jamous9,
  13. Daniel Behme10,
  14. Kevin Janot1,
  15. Guillaume Bellanger11,
  16. Cristophe Cognard11,
  17. Laurent Pierot2,
  18. Matthias Gawlitza7,8
  19. Compressive Aneurysm study group
    1. 1Department of Neuroradiology, CHRU Tours, Tours, France
    2. 2Department of Neuroradiology, Hôpital Maison Blanche, CHU Reims, Reims, France
    3. 3Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum,Universitätsklinik der Ruhr-Universität, Bochum, Germany
    4. 4Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Germany
    5. 5Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
    6. 6Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
    7. 7EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany
    8. 8Department of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
    9. 9Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
    10. 10Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
    11. 11Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, France
    1. Correspondence to Dr Matthias Gawlitza, Department of Neuroradiology, Dresden University Hospital, Dresden, 01307, Germany; matthias.gawlitza{at}ukdd.de

    Abstract

    Background Scientific data on the safety and efficacy of flow diverter stents (FDS) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms are scarce. We studied this subject in a retrospective international multicenter series, pooling data of 9 tertiary care neurointerventional departments.

    Objective To investigate, in a retrospective, multicentric cohort of patients presenting with visual or oculomotor symptoms attributed to a compressive carotid artery in an unruptured intracranial aneurysm, the safety and efficacy profiles of FDS, by analyzing neuro-opthalmologic symptom evolution following FDS placement, complications, and aneurysm obliteration rates.

    Methods All patients treated since 2015 with a FDS for an unruptured aneurysm of the ICA with signs of compressive cranial nerve symptoms (CN II, III, IV, VI) were included.

    Results We treated 55 patients with 55 aneurysms; 21 (38.2%) patients had oculomotor and 15 (27.3%) visual symptoms only; 19 (34.5%) presented with a combination of both. Treatment-related morbidity/mortality occurred in 7.2% and 3.6%, respectively. At last imaging follow-up (13.1±10.5 months) rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 72%, 14%, and 14%, respectively. At last clinical follow-up after 13±10.5 months, 19/51 (37.3%) patients had recovered completely and 18/51 (35.3%) had recovered at least partially from their neuro-ophthalmological symptoms. In multivariable models, a longer delay between symptom onset and treatment was associated with higher odds for incomplete recovery and lower odds for any improvement (aOR 1.03 (95% CI 1.01 to 1.07), p=0.047 and 0.04 (0–0.81), p=0.020). Incomplete recovery was independently associated with older age and fusiform aneurysms.

    Conclusion FDS are effective to treat patients with compressive aneurysms of the ICA causing neuro-ophthalmological symptoms, especially when treatment is initiated early after symptom onset, and aneurysm occlusion is adequate. However, serious complications are not rare.

    • aneurysm
    • flow diverter
    • cranial nerve
    • device
    • intervention

    Data availability statement

    Data are available upon reasonable request. Data can be made available after approval by the ethics committee of the corresponding author’s current institution.

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    Data availability statement

    Data are available upon reasonable request. Data can be made available after approval by the ethics committee of the corresponding author’s current institution.

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    Footnotes

    • Twitter @gboulouis

    • Collaborators Compressive Aneurysm study group: Pierre-François Manceau (Department of Neuroradiology, Hôpital Maison Blanche, 45 Rue Cognacq-Jay, Champagne-Ardenne University, Reims 51092, France);E-mail: pf.manceau@gmail.com, Maher Sahnoun (Department of Neuroradiology, Hôpital Maison Blanche, 45 Rue Cognacq-Jay, Champagne-Ardenne University, Reims 51092, France); E-mail: maher_sahnoun@yahoo.fr, Christophe Gelmini, department of Neuroradiology, Hôpital Maison Blanche, 45 Rue Cognacq-Jay, Champagne-Ardenne University, Reims 51092, France; E-mail: cgelmini@chu-reims.fr, Richard Bibi (Departement of Interventional Neuroradiology, CHRU de Tours, Tours, France); R.bibi@chu-tours.fr, Denis Herbreteau (Departement of Interventional Neuroradiology, CHRU de Tours, Tours, France); denis.herbreteau@univ-tours.fr, Heloïse Ifergan (Departement of Interventional Neuroradiology, CHRU de Tours, Tours, France); h.ifergan@chu-tours.fr, Nourou Dine Adeniran Bankolle (Departement of Interventional Neuroradiology, CHRU de Tours, Tours, France); bkadenir@gmail.com, Jennifer Linn (Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany); jennifer.linn@ukdd.de.

    • Contributors GBo: Acquisition of data, data analysis, drafting of manuscript, critical review of manuscript, approval of manuscript. SS, VM, SF, DL, JK, HS, CD, NA, CK, DK, AJ, DB, KJ, GBe, CC, LP: Acquisition of data, critical review of manuscript, approval of manuscript. MG: Acquisition of data, data analysis, drafting of manuscript, critical review of manuscript, approval of manuscript, guarantor of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SF: Consultancy contracts and payment of honoraria for lectures with Phenox, Microvention, Stryker, Kaneka Pharma, Rapid Medical. JK: Proctoring contract with Phenox and Microvention. CD: .Support for meetings and travel by Microvention, Vesalio. CK: Consultancy contracts and payment of honoraria for lectures with Microvention, Acandis. DB: Consultancy contracts with Phenox, ThrombX, Balt, Vesalio, Acandis; payment or honoraria for lectures by Vesalio, Acandis, Balt; support for meetings and travel by Vesalio. MG: Consultancy contract with Phenox; proctoring contract with MicroVention; member of the clinical event committee for a study on a flow diverter, sponsored by Microvention; received stents from Phenox for research purposes. The other authors declare no specific conflict of interest.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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