Visual complications after coil embolization of internal carotid artery aneurysms at the ophthalmic segment

Abstract

Background Coil embolization of aneurysms of the ophthalmic segment of the internal carotid artery (ICA-OphA ANs) has potential risks of visual complications. We analyzed this risk and focused on the relationship of the ophthalmic artery (OphA) origin with the aneurysm neck. Methods From January 2003 to April 2018, 179 unruptured ICA-OphA ANs were treated with endovascular surgery in our institution. Two ruptured and four aneurysms with missing data were excluded. Finally, 173 unruptured aneurysms were included in this study. The aneurysms were classified into three groups according to the location of the OphA origin: Separate, Shared, and Dome type. We retrospectively assessed visual complications based on the relationship between types of aneurysm and postoperative angiographic findings for the OphA. Results Visual deficits remained permanent in eleven cases (6.4%). In the Dome type, visual complications were significantly more frequent compared to the Separate type. Change in the OphA flow was significantly associated with a higher complication rate of 2.9%, but patients with changed OphA flow had a significant rate of 7.5% ( p = 0.020). We found no significant difference in the incidence of visual complications concerning the use of perioperative antithrombotic therapy. Conclusions The location of OphA origin regarding the aneurysmal neck and postoperative OphA flow were significantly correlated with the visual outcome after coil embolization for ICA-OphA ANs. Post-procedural flow in the OphA was an important factor affecting the rate of ischemic retinal complications. Retinal embolic events occurred with preserved flow in the OphA, albeit at a lower rate.

Dolichoectasia of the ophthalmic artery: A case report on the treatment strategy in endovascular therapy and literature review

“…The incidence rate of visual complications during coil embolization of IC-ophthalmic aneurysms is 10.4%, and the complications are believed to be caused by microemboli into the central retinal artery during coil embolization (19,20). In this case, blood ow in the OA was inhibited by the balloons, thereby preventing thrombus migration during embolization with strict heparinization.…”

Dolichoectasia of the ophthalmic artery: a case report on the treatment strategy in endovascular therapy and literature review

“…The incidence rate of visual complications during coil embolization of IC-ophthalmic aneurysms is 10.4%, and the complications are believed to be caused by microemboli into the central retinal artery during coil embolization [ 19 , 20 ]. In this case, a balloon-guided catheter as well as a balloon catheter was used with strict heparinization to obtain complete IC occlusion, because complete inhibition of prograde blood flow in the OA is necessary for preventing thrombus migration into retinal artery during embolization.…”

A point-of-care evaluation after visual loss following paraclinoid aneurysm repair: the role of sonographic and pupillometer assessment

“…Compressive, manipulative and thermal injuries to the optic nerve represent the most frequent causes of postoperative visual deficits related to the surgical treatment [4,[6][7][8]. Conversely, mass effect, ischemic event and post-procedural swelling related to perianeurysmal inflammation processes after endovascular treatment have been theorized as a possible mechanism responsible for the onset or worsening of visual deficits after the endovascular procedure, with a 6.4% rate of permanent visual disturbances [9,10]. Therefore, physicians who routinely manage aSAH in the clinical practice should be aware of this complication and the techniques for an appropriate management, in order to provide a prompt and targeted response to deal with this emergency.…”