← Back to Previous Page

 

P472: STRATEGY-SPECIFIC COMPLICATION PHENOTYPES IN OPHTHALMIC-SEGMENT ICA ANEURYSMS: A THREE-PATIENT CASE SERIES ACROSS FLOW DIVERSION (SAC TO FDS) AND PRIMARY COILING
Raghuram Padmanabhuni, BS¹; Siddharth Karthikeya, BS²; Yiyi Chen, BS¹; Arman Sourani, MD³; Abilash Haridas, MD, FAANS, FCNS, FABPNS⁴; ¹University of California, Los Angeles; ²University of California, Irvine; ³Neurosurgery department of Isfahan University of Medical Sciences; ⁴Astra Neurosurgical Institute

Background: Ophthalmic-segment internal carotid artery aneurysms (ICA-OphA) present unique therapeutic challenges given factors like their location, variable rupture status, and propensity for treatment-related complications. In fact, despite innovations in endovascular therapy—flow-diversion stents (FDS), stent-assisted coiling (SAC), and primary coiling—inter-patient complication profiles differ considerably. These three-cases in series highlight distinct complication phenotypes associated with strategy-specific management of ophthalmic-segment aneurysms.

Methods: This series is a retrospective review of three females (46–67 y) with ICA-OphA aneurysms treated by the following: (1) flow-diverting stent (FDS), (2) stent-assisted coiling (SAC) with interval overlapping FDS, and (3) primary coiling. We then discuss clinical courses, imaging, peri/post-operative complications, and discharge outcomes for the three cases.

Results

• Patient 1 (FDS, ruptured)
  • Presents fisher 3 SAH from right ICA-OphA aneurysm (7×9 mm). After DAPT loading and FDS, the patient developed delayed in-stent thrombosis with hemispheric infarction requiring decompressive hemicraniectomy. The patient discharged GCS 15 with hemiplegia.
• Patient 2 (SAC→FDS, unruptured)
  • Presents monocular vision loss with ICA-OphA aneurysm (12×8 mm). Initial SAC followed by regrowth at 6 months. The patient treated with overlapping FDS. 6-month angiography showed complete occlusion with vision stable.
• Patient 3 (Primary coiling, ruptured)
  • Presents fisher 2 SAH from ICA-OphA aneurysm (4×9 mm). Intra-procedural rupture during catheterization managed with rapid coil occlusion. The CT showed focal ICH. The patient discharged GCS 15 with persistent aphasia and hemiparesis.

Conclusions: Across three strategies, we observed distinct complication phenotypes including delayed thrombosis after FDS, interval regrowth after SAC requiring FDS, and intra-operative rupture with primary coiling. The 3 female-patient series emphasizes that recognizing patterned risks is critical for strategy selection, DAPT planning/monitoring, surveillance intervals, and patient counseling.

Learning Points

• Technique matters: FDS—watch for delayed thrombotic events; SAC—plan follow-up for regrowth; primary coiling—highest intraprocedural rupture risk.
• Surveillance should match strategy: early imaging for thrombotic complications after FDS; 3–6 mo angiography after SAC to detect recurrence.
• Optimize antiplatelet/anticoagulation protocols and platelet-function testing when using FDS.
• Document Raymond–Roy class and neurologic outcomes to correlate mechanism and prognosis.

View Poster

 

← Back to Previous Page