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  • Cavernous Carotid Aneurysms in the Era of Endoluminal Reconstruction: A Need to Revisit Treatment Paradigms

    Final Number:

    Omar Tanweer MD; Eytan Raz; Andrew S Brunswick MD; Daniel Walter Zumofen MD; Maksim Shapiro; Howard A. Riina MD, FACS; Mohamed Fouladvand; Tibor Becske MD; Peter K. Nelson MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Recent techniques of endoluminal reconstruction with flow diverting stents have not been incorporated into treatment algorithms for Cavernous Carotid Aneurysms (CCAs). This study examines the authors’ institutional experience as well as a systematic review of the literature for outcomes and complications of using the Pipeline Emoblization Device (PED) in unruptured CCAs.

    Methods: A retrospective search for CCAs from a prospective collected database of aneurysms treated with the PED at our institution was done. Baseline demographic, clinical and laboratory values were collected. Intra-interventional data as well as data at all follow-up visits were also collected. A systematic review of the literature for complication data was performed with inquires sent when clarification of data was needed.

    Results: Forty-three CCAs, were included in the study. Our mean radiographic follow-up was 2.05 years. On last follow-up, 88.4% of the aneurysms treated had complete or near-complete occlusion of their aneurysm. Aneurysm complete or near complete occlusion rates at 6 months, 12 months and 36 months were 81.4%, 89.7% and 100%, respectively. Of patients with neuro-ophthalmological deficits on presentation, 84.2% had improvement in their visual complaints. Overall, we had a 0% mortality rate and a 2.3% major neurological complication rate. Our systematic review of the literature yielded 227 CCA treated with PED with a mortality and morbidity rate of, 0.4% and 3.1% respectively.

    Conclusions: Endoluminal reconstruction with flow diversion for large unruptured CCAs can yield high efficacy with low complications. Further long-term data will be helpful in assessing durability of cure however we advocate for a re-visiting of current management paradigms for CCAs.

    Patient Care: It draws attention to the need to revisit a treatment paradigm that would include the most recent treatment options.

    Learning Objectives: Management of Cavernous Carotid Aneurysms


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