Endovascular treatment for ophthalmic segment aneurysms of internal carotid: clinical analysis of 23 patients

Objective: To evaluate the safety and efficacy of endovascular embolization in treating ophthalmic segment aneurysms of internal carotid. Methods During the period from July 2008 to August 2013, a total of 23 patients with ophthalmic segment aneurysms of internal carotid were admitted to authors' hospital to receive endovascular embolization. According to Hunt-Hess classification, grade I lesion was seen in 11 cases, grade n in 10 cases and grade III in 2 cases. The aneurysm diameter ranged from 2.2 mm to 19.9 mm, with a mean diameter of 5.7 mm. After the treatment follow-up examinations with DSA, MRA and modified Rankin scale were conducted to evaluate the therapeutic results. Results: A total of 27 ophthalmic segment aneurysms were detected in 23 patients. Endovascular embolization was performed with guglielmi detachable coils (n = 15) or solitaire AB stent-assisted coil (n = 12). The therapeutic results immediately after the embolization were graded by Raymond classification. Complete obliteration (Grade I) was obtained in 22 aneurysms, residual neck (grade II) in 4 aneurysms and residual aneurysm (grade III) in one aneurysm. Procedure-related complications occurred in 3 patients, including thrombosis in the aneurysm neck (n = 1), tail of the coil protruding into the stent (n =1) and transient blindness (n = 1). Eighteen patients were followed up for 2-62 months. Follow-up examinations with angiography showed that complete embolization of the aneurysm was obtained in 15 cases (84%) and subtotal embolization of the aneurysm was seen in 3 cases (16%). In one patient who had bilateral aneurysms, the aneurysm on the untreated side was enlarged with increasing time. During the follow-up period, 18 patients had a modified Rankin score of 0-1, and all these patients had stable clinical condition with no newly-developed neurological dysfunction or re-bleeding. Conclusion: For the treatment of ophthalmic segment aneurysms of internal carotid, endovascular embolization is minimally-invasive, safe and effective, although its long-term effect and safety need to be further studied. (authors)