Delayed Visual Deficits and Monocular Blindness After Endovascular Treatment of Large and Giant Paraophthalmic Aneurysms

Abstract

Both acute and delayed visual disturbances can present after the endovascular treatment of carotid artery paraophthalmic aneurysms. Delayed visual deterioration can be observed up to 35 days after embolization. Although the cause is still undefined, it is likely that the more delayed visual deterioration can be attributed to progression of mass effect and/or perianeurysmal inflammatory change. Our case series raises the possibility that this phenomenon may be more likely with HydroCoil (HydroCoil Embolic System; MicroVention, Aliso Viejo, CA). This possibility should be taken into account by neurointerventionists when selecting a coil type to treat large paraophthalmic aneurysms.

Patients Prone to Recurrence after Endovascular Treatment: Periprocedural Results of the PRET Randomized Trial on Large and Recurrent Aneurysms

“…Inflammatory problems (cranial nerve deficits, meningitislike syndromes, and hydrocephalus in patients with unruptured aneurysms) have previously been reported with the use of hydrogel coils. 13,18,[22][23][24][25] Even though reports such as "increased mass effect" or "inflammation" were slightly more frequent with hydrogel (5 versus 2 platinum), we did not find a significant difference with platinum or did not show an impact on treatment morbidity. Differences in immediate angiographic outcomes, with a higher (but not statistically significant) proportion of residual aneurysms after hydrogel coiling, have been reported in the HELPS trial.…”

Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial

“…14,22,[24][25][26][27] In PRET, adverse events that have been (rightly or wrongly) attributed to inflammation were transient and occurred rarely and with equal frequency in both groups.…”

Neuroophthalmological outcomes associated with use of the Pipeline Embolization Device: analysis of the PUFS trial results

“…The safety and efficacy of the PED has been unequivocally demonstrated for these aneurysms of the cavernous and supraclinoid segments of the ICA. 2,10 Although the treatment of large and giant ICA aneurysms with mass-occupying coils is very frequently associated with negative neuroophthalmological outcomes 17 -observed with both hydrogel-coated coils 12,14 and platinum coils 5 -the absence of an intrasaccular element in PEDbased treatment theoretically permits a reduction in mass effect accompanying aneurysmal involution with the potential to facilitate resolution of compression-related CN deficits and optic neuropathy. The Pipeline for Uncoilable or Failed Aneurysms (PUFS) is a prospective, multicenter, and single-arm clinical trial of the PED for the treatment of unruptured large and giant aneurysms of the ICA.…”