Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Heilongjiang Province, 150001, Harbin, People's Republic of China.
Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Acta Neurochir (Wien). 2022 Aug;164(8):2191-2202. doi: 10.1007/s00701-022-05239-1. Epub 2022 May 13.
Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes.
We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid-ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: type A, OA originating separate from the aneurysm; type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment.
The median follow-up time was 6.8 months (range, 5.3-20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.854, 95% confidence interval [CI] 1.878-12.548, P = 0.001). Visual symptoms at final follow-up correlated with preoperative visual symptoms (OR 22.777, 95% CI 3.115-166.555, P = 0.002).
Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.
眼动脉周围动脉瘤是一种特殊类型的动脉瘤。我们评估了眼动脉（OA）起源与动脉瘤之间的关系，并研究了Pipeline 栓塞装置（PED，Covidien/Medtronic）联合或不联合线圈对动脉瘤闭塞率和视力结果的影响。
我们回顾性分析了 2014 年 11 月至 2019 年 10 月在中国上市后多中心注册研究中 1171 例接受 PED 治疗的患者中的 189 例 194 例眼动脉周围动脉瘤。眼动脉周围动脉瘤定义为起源于颈内动脉背侧壁的颈内-眼动脉段动脉瘤，位于 OA 起源处或其远端，呈上或上内侧突出。OA 起源与动脉瘤之间的关系分为以下两类：A型，OA 与动脉瘤分离起源；B 型，OA 起源于动脉瘤颈部或瘤顶。根据治疗方法将有动脉瘤的患者分为 PED 组和 PED+线圈组。
中位随访时间为 6.8 个月（范围 5.3-20.2 个月）。163 个动脉瘤闭塞（84%），31 个动脉瘤不完全闭塞（16%）。多变量分析显示，PED 组中 B 型动脉瘤是不完全闭塞的危险因素（比值比[OR]4.854，95%置信区间[CI]1.878-12.548，P=0.001）。最终随访时的视力症状与术前视力症状相关（OR 22.777，95%CI 3.115-166.555，P=0.002）。
PED 单纯治疗后 B 型动脉瘤的闭塞率较低。术前有视力症状的患者应及时治疗，避免永久性视力症状。
