The Source for Neurovascular News and Education

March 29, 2024

 

But no major ophthalmic complications were seen in this study of patients being treated for carotid-ophthalmic aneurysms.

 

Patients who are treated for carotid-ophthalmic aneurysms using flow diverters that cover the optic artery may experience minor eye changes, according to a small retrospective analysis published online March 23, 2018, ahead of print in the Journal of NeuroInterventional Surgery.

 

Animal aneurysm models have shown satisfactory results when flow diverters are used with respect to the preserved patency of covered arterial branches, Romain Touzé, MD (Pitié-Salpêtrière Hospital, Paris, France), and colleagues write.

 

Nevertheless, they say, daily clinical use of these devices has revealed some acute or delayed complications associated with coverage of side branches, especially when the ophthalmic artery and the anterior choroidal artery are involved.

 

While coverage of the ophthalmic artery with a flow diverter is safe in terms of visual outcome, “no ophthalmic examination performed by an ophthalmologist was performed in any of these series, as long as the patient remained clinically asymptomatic,” Touzé et al stress. Yet one 2015 study involving thorough more eye exams reported that nearly four in 10 patients developed new visual complications after their interventions, they add.

 

The investigators conducted a retrospective analysis of a single-center database that included 30 patients treated from October 2009 to April 2015 for a noncompressive carotid-ophthalmic intracranial aneurysm using a flow diverter. In all cases, the ophthalmic artery was covered by the device. A total of 15 patients were excluded from the analysis. Of these, nine were lost to follow-up, five denied participation, and one was found to have a compressive aneurysm.

 

The 15 remaining patients with 16 carotid-ophthalmic aneurysms underwent a systematic and extensive ophthalmic examination by two ophthalmologists at least 2 years after the stent placement. After a follow-up period of 4.1±2 years, six patients (40%), presented with ophthalmic complications, including three cases of amaurosis fugax (18.8%) and four significant visual field defects (25%).

 

Comparing each eye’s visual field revealed significant differences between the eye on the flow diverter side compared with the contralateral eye, with a mean deviation of -1.58 dB versus -0.67 dB, respectively (P = 0.003). Visual acuity was preserved in all patients.

 

“Ophthalmic complications observed in our series consisted almost exclusively in visual field impairment on the ‘flow diverter side’ and amaurosis fugax,” write the authors. “Vascular impairment is thought to be the main mechanism to explain such abnormalities.”

 

They hypothesized two pathological mechanisms for these findings. One is development of small retinal emboli. Another possibility is a hemodynamic cause based on a noneffective balance between the internal and the external carotid arteries to the ophthalmic artery after flow diverter placement, which “may cause a low-flow in the ophthalmic supply despite collateral by the ECA,” the researchers suggest.

 

The authors conclude that interventional neuroradiologists should be aware of the possible visual complications associated with use of flow diverters and inform their patients of these risks.

 


Source:

Touzé R, Touitou V, Shotar E, et al. Long-term visual outcome in patients treated by flow diversion for carotid-ophthalmic aneurysms. J NeuroInterv Surg 2018;Epub ahead of print.

 

Disclosures:

Touzé reports no relevant conflicts of interest.