Visual complications after stent-assisted endovascular embolization of paraophthalmic and suprasellar variant superior hypophyseal aneurysms: The duke cerebrovascular center experience in 57 patients

Objective: To review retrospectively experience with stent-assisted coiling of ophthalmic segment internal carotid artery (ICA) aneurysms to report outcome data and identify the rate of associated visual complications. Methods: The Duke endovascular database was retrospectively reviewed to identify all ICA aneurysms treated with stent-assisted embolization between November 2002 and October 2009. Only aneurysms arising from the ophthalmic segment of the ICA and originating from the paraophthalmic or suprasellar variant superior hypophyseal artery were included. These aneurysms have the potential to create visual disturbances related to mass effect on the optic nerve or chiasm or to disrupt the ophthalmic artery. Chart review was performed to obtain clinical information, immediate incidence, and follow-up of aneurysm remnants and any visual complications. Results: There were 63 aneurysms (48 paraophthalmic and 15 suprasellar variant superior hypophyseal) identified in 57 patients. The ophthalmic artery was preserved in all but two (3.5%) cases, neither of which resulted in visual deficits. One (1.8%) patient experienced transient acute visual disturbances, and two (3.5%) patients had delayed, persistent deficits. Conclusions: Stent-assisted embolization of ophthalmic segment ICA aneurysms is technically achievable and in our series did not appear to result in increased visual complications compared with coil embolization alone or surgical treatment.