Treatment of ophthalmic segment carotid aneurysms using the pipeline embolization device: clinical and angiographic follow-up

Objectives: Aneurysms of the ophthalmic segment of the internal carotid artery (ICA) often present unique challenges to endovascular treatment due to their proximity to or involvement of the ophthalmic artery, and the subsequent risk of post-operative visual complications. The pipeline embolization device (PED) represents a paradigm shift and promising new therapy in the treatment of intracranial aneurysms. We reviewed the ophthalmic segment ICA aneurysms treated with the PED at Barrow Neurological Institute (BNI) to report outcome data, including patency of the ophthalmic artery and visual complications. Methods: The prospectively maintained BNI endovascular database was reviewed for all patients with ophthalmic segment ICA aneurysms treated with the PED since May 2011. Patient charts and digital subtraction angiograms were reviewed to report angiographic outcomes and visual complications. Only patients with at least 6 months of follow-up were included in the analysis. Results: Of 30 patients treated with ophthalmic segment aneurysms during the study period, sufficient follow-up was available for 29 patients with 38 aneurysms, all of which were treated electively. The PED was successfully deployed for all lesions, with 92.1% complete or near-complete obliteration rate at angiographic follow-up. All but one patient were found to have a patent ophthalmic artery at short-term follow-up and 100% of patients retained intact vision. Five patients had minor periprocedural hemorrhagic complications but no permanent morbidities. There were no intracranial hemorrhages, thromboembolic phenomena, vessel dissections, or mortalities. Conclusion: Treatment of ophthalmic segment ICA aneurysms with the PED is safe and effective at shortterm follow-up.