George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA.
Neurosurgery. 2024 Mar 1;94(3):538-544. doi: 10.1227/neu.0000000000002694. Epub 2023 Sep 18.
Flow diverter (FD) treatment for aneurysms of the ophthalmic segment of the internal carotid artery (ICA) may raise concerns about visual morbidity related to coverage of the ophthalmic artery by the device. Our objective was to evaluate clinical and angiographic outcomes associated with FD treatment of these aneurysms, with particular emphasis on visual morbidity.
We performed a retrospective analysis of the endovascular databases at 2 US centers to identify consecutive patients with aneurysms along the ophthalmic segment of the ICA that were treated with FDs between January 2010 and December 2022. Baseline demographics, aneurysm characteristics, and periprocedural and postprocedural data, including the occurrence of visual complications, were collected.
One hundred and thirteen patients with 113 aneurysms were identified for inclusion in this study. The mean age of the patients was 59.5 ± 12.4 years, and 103 (91.2%) were women. The ophthalmic artery origin was involved in 40 (35.4%) aneurysms, consisting of a neck origin in 33 (29.2%) and a dome origin in 7 (6.2%). New transient visual morbidity during the hospital stay included impaired visual acuity or blurriness in 1 (0.9%) patient, diplopia in 1 (0.9%), and floaters in 1 (0.9%). New transient visual morbidity during follow-up included impaired visual acuity or blurriness in 5 patients (4.4%), diplopia in 3 (2.7%), ipsilateral visual field defect in 1 (0.9%), and floaters in 6 (5.3%). Permanent visual morbidity occurred in 1 patient (0.9%). Among the 101 patients who had angiographic follow-up, the Raymond-Roy occlusion classifications were I (complete aneurysm occlusion) in 85 (84.2%), II (residual neck) in 11 (10.9%), and III (residual aneurysm) in 5 (4.9%).
In our experience, flow diversion for ICA ophthalmic segment aneurysms resulted in low rates of visual morbidity, which was mostly transient in occurrence.
血流导向装置（FD）治疗颈内动脉眼段（ICA）动脉瘤可能会引起对装置覆盖眼动脉引起的视力损伤的担忧。我们的目的是评估 FD 治疗这些动脉瘤的临床和血管造影结果，特别强调视力损伤。
我们对 2 个美国中心的血管内数据库进行了回顾性分析，以确定 2010 年 1 月至 2022 年 12 月期间使用 FD 治疗的 ICA 眼段动脉瘤的连续患者。收集了基线人口统计学、动脉瘤特征以及围手术期和术后数据，包括视觉并发症的发生情况。
本研究共纳入 113 例 113 个动脉瘤患者。患者的平均年龄为 59.5±12.4 岁，103 例（91.2%）为女性。眼动脉起源处受累的动脉瘤有 40 个（35.4%），其中颈内起源 33 个（29.2%），瘤顶起源 7 个（6.2%）。住院期间新出现的短暂性视力损伤包括 1 例（0.9%）视力或视力模糊受损，1 例（0.9%）复视，1 例（0.9%）飞蚊症。随访期间新出现的短暂性视力损伤包括 5 例（4.4%）视力或视力模糊受损，3 例（2.7%）复视，1 例（0.9%）同侧视野缺损，6 例（5.3%）飞蚊症。1 例（0.9%）发生永久性视力损伤。在 101 例有血管造影随访的患者中，Raymond-Roy 闭塞分类为 I 级（完全动脉瘤闭塞）85 例（84.2%），II 级（残留瘤颈）11 例（10.9%），III 级（残留动脉瘤）5 例（4.9%）。
根据我们的经验，FD 治疗 ICA 眼段动脉瘤的视力损伤发生率较低，且大多为短暂性。
