Ophthalmic segment internal carotid artery aneurysms endovascular treatment

Aim. To estimate the nearest and distant angiographic results of endovascular occlusion of aneurysms of the internal carotid artery ophthalmic segment using non‑reconstructive treatment methods.

Materials and methods. The results of endovascular treatment of 75 patients with aneurysms of the ophthalmic segment of the internal carotid artery admitted to the Neurosurgical Department No. 3 of the V. L. Polenov Russian Research Neurosurgical Institute, from January 1, 2013 to December 31, 2016 were analyzed.

Results. Of 75 aneurysms, 52 (69.3 %) were radically occluded from the blood flow (Type A) and 23 (30.7 %) were sub‑totally (Type B). When isolated occlusion with detachable coils was used, radical result was achieved in 13 (59.1 %) out of 22 cases, subtotal occlusion – in 9 (40.9 %). During balloon‑assisted occlusion 39 (73.6 %) out of 53 aneurysms were shut off from the blood flow totally, 14 (26.4 %) – sub‑totally. Partial aneurysm occlusion (Type C) was not achieved in any of the observations. Recurrence was observed in 3 (30 %) out of 10 cases on control angiography after isolated occlusion with detached spirals, and 2 (20 %) required repeated surgical intervention. From 38 aneurysms operated on using balloon‑assistence, 9 (23,7 %) recurred on control angiography, 6 of them (15,8 %) required repeated surgical intervention.

Conclusion. Nonconstructive surgical interventions for occlusion of aneurysms of the internal carotid artery ophthalmic segment are still urgent and effective method of treatment of patients in acute period of aneurysm rupture combined with somatic status; however, they are inferior to reconstructive surgeries concerning radica lity in the long‑term period.

1. Toma N. Anatomy of the ophthalmic artery: embryological consideration. Neurol Med Chir (Tokyo) 2016;56(10):585–91. DOI: 10.2176/nmc.ra.2015-0324

2. Bouthillier A., van Loveren H.R., Keller J.T. Segments of the internal carotid artery: a new classification. Neurosurgery 1996;38(3):425–32; discussion 432–3. DOI: 10.1097/00006123-199603000-00001

3. Day A.L. Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 1990;72(5):677–91. DOI: 10.3171/jns.1990.72.5.0677

4. Gibo H., Lenkey C., Rhoton A.L. Jr. Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 1981;55(4):560–74. DOI: 10.3171/jns.1981.55.4.0560

5. Durst C.R., Starke R.M., Gaughen J. et al. Vision outcomes and major complications after endovascular coil embolization of ophthalmic segment aneurysms. AJNR Am J Neuroradiol 2014;35(11):2140–5. DOI: 10.3174/ajnr.A4032

6. Kanagalingam S., Gailloud P., Tamargo R.J. et al. Visual sequelae after consensus-based treatment of ophthalmic artery segment aneurysms: the Johns Hopkins experience. J Neuroophthalmol 2012;32(1):27–32. DOI: 10.1097/WNO.0b013e31823b6c60

7. Arustamyan S.R., Yakovlev S.B., Shakhnovich A.R. et al. Results of deconstructive endovascular surgery in treatment of large and giant intracranial aneurysms. Zhurnal Voprosy neirokhirurgii im. N.N. Bur- denko = Burdenko’s Journal of Neurosurgery 2016;80(5):22–31. (In Russ., In Engl.). DOI: 10.17116/neiro201680522-31

8. Rozhchenko L.V., Bobinov V.V., Goroshchenko S.A. et al. Cellular, genetic and epigenetic mechanisms of cerebral aneurysm growth. Sovremennye problemy nauki i obrazovaniya = Modern Problems of Science and Education 2021;2. (In Russ.). DOI: 10.17513/spno.30560

9. Lejeune J.P., Thines L., Proust F. et al. Selective microsurgical treatment of giant intracranial aneurysms. Neurochirurgie 2016;62(1):30–7. DOI: 10.1016/j.neuchi.2015.12.001

10. Chalouhi N., Hoh B.L., Hasan D. Review of cerebral aneurysm formation, growth, and rupture. Stroke 2013;44(12):3613–22. DOI: 10.1161/STROKEAHA.113.002390

11. Bobinov V.V., Rozhchenko L.V., Goroshchenko S.A. et al. The evolution of non-reconstructive methods of endovascular treatment of cerebral aneurysms. Meditsinskii akademicheskii zhurnal = Medical academic journal 2022;22(3):105–14. DOI: 10.17816/MAJ108576

12. Brinjikji W., Piano M., Fang S. et al. Treatment of ruptured complex and large/giant ruptured cerebral aneurysms by acute coiling followed by staged flow diversion. J Neurosurgery 2016;125(1):120–7. DOI: 10.3171/2015.6.JNS151038

13. Vyazgina E.M., Ivanova N.E., Ivanov A.Yu. et al. Double antiagregant therapy after installation of intracranial stents for cerebral aneurysms. Rossiiskii neirokhirurgicheskiy zhurnal im. prof. A.L. Polenova = Russian Journal of Neurosurgery 2019;11(1):8–14. (In Russ.).

14. Molyneux A.J., Birks J., Clarke A. et al. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 2015;385(9969):691–7. DOI: 10.1016/S0140-6736(14)60975-2

15. Spetzler R.F., McDougall C.G., Zabramski J.M. et al. Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg 2019;132(3):771–6. DOI: 10.3171/2018.8.JNS181846

16. Elijovich L., Higashida R.T., Lawton M.T. et al. Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study. Stroke 2008;39(5):1501–6. DOI: 10.1161/STROKEAHA.107.504670

17. Moret J., Cognard C., Weill A. et al. The “remodelling technique” in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol 1997;3(1):21–35. DOI: 10.1177/159101999700300103

18. Rozhchenko L.V., Ivanov A.Yu., Dryagina N.V. et al. Correction of thromboembolic complications in endovascular embolization. Translyatsionnaya meditsina = Translational Medicine 2016;3(1):98–105. (In Russ.). DOI: 10.18705/2311-4495-2016-3-1-98-105

19. Berestov V.V., Orlov K.Yu., Krivoshapkin A.L. et al. Stent-assisted coiling of acute ruptured cerebral aneurysms. Sibirskiy nauchnyy medicinskiy zhurnal = Siberian Scientific Medical Journal 2021;41(4):40–7. (In Russ.). DOI: 10.18699/SSMJ20210405

20. Bobinov V.V., Rozhchenko L.V., Petrov A.E. et al. Early and longterm results of endovascular treatment of cerebral aneurysms. Neyrokhirurgiya = Russian Journal of Neurosurgery 2023;25(2):10–19. DOI: 10.17650/1683-3295-2023-25-2-10-19