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  • Pipeline Embolization Device for Small Paraophthalmic Artery Aneurysms with Emphasis on Anatomical Relationship of Ophthalmic Artery Origin and Aneurysm

    Final Number:

    C. J. Griessenauer MD; C. S. Ogilvy MD; P. M. Foreman MD; M. H. Juan Chua BS; M. R. Harrigan MD; C. J. Stapleton MD; A. B. Patel MD; L. He MD; M. Fusco MD; J D. Mocco MD; P. A. Winkler; A. Patel MD, MPH; A. J. Thomas MD

    Study Design:
    Clinical trial

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting

    Introduction: Contemporary treatment for paraophthalmic artery aneurysms includes flow diversion utilizing the Pipeline Embolization Device (PED). Little is known, however, about potential implications of the anatomical relationship of ophthalmic artery origin and aneurysm.

    Methods: Four major academic institutions in the United States (US) provided data on small paraophthalmic aneurysms (= 7 mm) treated with PED between 2009 and 2015. The anatomical relationship of ophthalmic artery origin and aneurysm, radiographic outcome of aneurysm occlusion, and patency of ophthalmic artery (OA) were assessed. Ophthalmic artery origin was classified as follows: Type 1 - OA separate from aneurysm, Type 2 - OA from aneurysm neck, and Type 3 - OA from aneurysm dome. Clinical outcome was assessed using the modified Rankin Scale and visual deficits were categorized as transient or permanent.

    Results: The cumulative number of small paraophthalmic aneurysms treated with PED between 2009 and 2015 at the four participating institutions was 69 in 52 patients. The distribution of OA origin was 72.5% for Type 1, 17.4% for Type 2, and 10.1% for Type 3. Radiographic outcome at last follow up (median 11.5 months) showed complete, near complete, and incomplete occlusion rates of 81.5%, 5.6%, and 12.9%, respectively. Two aneurysms (3%) resulted in transient visual deficits and no permanent deficits occured. At last follow up the OA was patent in 96.8%. Type 3 ophthalmic artery origin was associated with a lower rate of complete aneurysm occlusion (p = 0.0297), a trend towards visual deficits (p = 0.0797), and a lower rate of OA patency (p = 0.0783).

    Conclusions: Pipeline embolization treatment of small paraophthalmic aneurysms is safe and effective. Aneurysms where the ophthalmic artery is arising from the aneurysm dome may be associated with lower rates of aneurysm occlusion and ophthalmic artery patency and higher rates of transient visual deficits.

    Patient Care: Information on safety and efficacy of flow diversion of paraophthalmic aneurysms is reported.

    Learning Objectives: By the conclusion of this session, participants should be able to discuss the role of flow diversion for treatment of paraophthalmic aneurysms and implications of the anatomic relationship of the ophthalmic artery to the aneurysm.


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