Retrospective evaluation of endovascular treatment of intracranial paraophtalmic aneurysms with the flow diverter stent i̇mplantation

Purpose: Surgical and endovascular methods are widely used in the treatment of cerebral aneurysms. The desired success cannot be achieved with the use of the classical endovascular methods in the treatment of wide-necked and large aneurysms. For this reason , flow diverter stents have been widely used for the past 11-12 years. In this study, we aimed to reveal the efficacy and safety of treatment with flow diverter stents in patients with wide neck intracranial paraophthalmic aneurysms. Materials and method: Our retrospective designed study protocol was approved by the institutional ethics committe of our university in accordance with the declaration of Helsinki, a total of 87 patients, 66 females (75,8%) and 21 males (24,2%) ranging of age between 22 to 77 years (mean 51,1) who were treated with flow diverter stents in our vascular interventional radiology department between october 2008 and january 2020 included in the study. Clinical data of the patients, DSA images in the pre- procedure, procedure and follow-up were evaluated. Results: In our department, after obtaining written informed consent from all patients, a total of 87 patients with 100 paraophthalmic segment aneurysms were embolized with flow diverting stents. More than one aneurysm was detected in 34 patients (39%), 6 patients (6,9%) had multiple same sided ophthalmic segment aneurysms and 8 patients (9,2%) had bilateral ophthalmic segment aneurysm. Eleven (12,6%) of the 87 patients had been treated previously surgically or endovascularly. Coil embolization was additionally performed in 40 paraophtalmic segment aneurysms (40%). Thirteen patients (14,9%) had a history of subarachnoid hemorrhage. During the procedure, there was a problem of incomplete opening in five stents (5%). All stents were placed in the desired localization (Technical success 100%). Thromboembolic complications developed in one patient during the procedure, in 1 patient immediately after the procedure and in 5 patients in the late period (Total thromboembolic complication rate 8.1%). ICA occlusion occur in 3 patients in the 3-6th months and 1 patient had permanent hemiparesis secondary to ICA occlusion (Permanent morbidity rate 1.1%). One patient died on the 5th day due to bleeding (Mortality rate 1.1%). Stent stenosis developed in 11 patients (12.6%), 2 of which were symptomatic in the late period. The total aneurysm occlusion rate was 93.6%. Conclusion: The flow diverter stent implantation with or without concomitant coil embolization is a safe and efficient method in the treatment of intracranial paraophtalmic aneurysms. Anahtar Kelimeler: Intracranial aneurysm, Paraophtalmic, Flow diverter, Stent, Endovascular embolization, Endovascular treatment.