Mid- and Long-Term Outcomes Following Flow Diversion for Carotid-Ophthalmic Aneurysms: a Single-Centre Experience.

Abstract

Background and purpose: Flow diverter stents (FDS) have shown promise in treating carotid-ophthalmic aneurysms (COAs), but mid- to long-term data remain limited. This study reports our institutional experience using FDS for unruptured COAs.

Methods: Between August 2010 and September 2023, 105 unruptured COAs in 99 patients (87 females, mean age 54 ± 14 years) were retrospectively analyzed. The anatomical relationship between the ophthalmic artery (OphA) and the aneurysm was classified as Type 1 (separate), Type 2 (neck), or Type 3 (dome). Patients were treated with FDS alone or with adjunctive coiling. Clinical and angiographic outcomes, including visual complications, were assessed.

Results: Technical success was 98.1%. At a mean follow-up of 38.5 months, complete occlusion was achieved in 89.1% and adequate occlusion in 98.0%. Occlusion rates were comparable across types, with a trend toward lower rates in Type 2. Retreatment was required in 1.0%. Major adverse events occurred in 1.0%, neurological complications in 3.0%, and in-stent stenosis in 2.0%. New visual deficits occurred in 6.1% (4.0% transient, 2.0% permanent). Aneurysm size > 12 mm was significantly associated with persistent symptoms (p = 0.003). Preoperative visual symptoms were the only independent predictor of poor visual outcome. Outcomes were comparable between FDS-only and FDS+coiling groups.

Conclusion: FDS, with or without coiling, is a safe and effective treatment for COAs, achieving durable occlusion and generally favorable visual outcomes. The OphA-aneurysm relationship may influence occlusion, although residual filling may also reflect physiological flow preservation. Early treatment is essential in patients with large aneurysms and visual symptoms.