Universität zu Köln

Boulouis, Gregoire ORCID: 0000-0001-8422-9205, Soize, Sebastien, Maus, Volker ORCID: 0000-0001-5097-2631, Fischer, Sebastian, Lobsien, Donald, Klisch, Joachim, Styczen, Hanna, Deuschl, Cornelius, Abdullayev, Nuran ORCID: 0000-0003-4522-537X, Kabbasch, Christoph ORCID: 0000-0003-3712-2258, Kaiser, Daniel ORCID: 0000-0001-5258-0025, Jamous, Ala, Behme, Daniel, Janot, Kevin, Bellanger, Guillaume, Cognard, Cristophe, Pierot, Laurent and Gawlitza, Matthias . Flow diversion for internal carotid artery aneurysms with compressive neuro-ophthalmologic symptoms: clinical and anatomical results in an international multicenter study. J. NeuroInterventional Surg.. LONDON: BMJ PUBLISHING GROUP. ISSN 1759-8486

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Abstract

Background Scientific data on the safety and efficacy of flow diverter stents (FDS) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms are scarce. We studied this subject in a retrospective international multicenter series, pooling data of 9 tertiary care neurointerventional departments. Objective To investigate, in a retrospective, multicentric cohort of patients presenting with visual or oculomotor symptoms attributed to a compressive carotid artery in an unruptured intracranial aneurysm, the safety and efficacy profiles of FDS, by analyzing neuro-opthalmologic symptom evolution following FDS placement, complications, and aneurysm obliteration rates. Methods All patients treated since 2015 with a FDS for an unruptured aneurysm of the ICA with signs of compressive cranial nerve symptoms (CN II, III, IV, VI) were included. Results We treated 55 patients with 55 aneurysms; 21 (38.2%) patients had oculomotor and 15 (27.3%) visual symptoms only; 19 (34.5%) presented with a combination of both. Treatment-related morbidity/mortality occurred in 7.2% and 3.6%, respectively. At last imaging follow-up (13.1 +/- 10.5 months) rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 72%, 14%, and 14%, respectively. At last clinical follow-up after 13 +/- 10.5 months, 19/51 (37.3%) patients had recovered completely and 18/51 (35.3%) had recovered at least partially from their neuro-ophthalmological symptoms. In multivariable models, a longer delay between symptom onset and treatment was associated with higher odds for incomplete recovery and lower odds for any improvement (aOR 1.03 (95% CI 1.01 to 1.07), p=0.047 and 0.04 (0-0.81), p=0.020). Incomplete recovery was independently associated with older age and fusiform aneurysms. Conclusion FDS are effective to treat patients with compressive aneurysms of the ICA causing neuro-ophthalmological symptoms, especially when treatment is initiated early after symptom onset, and aneurysm occlusion is adequate. However, serious complications are not rare.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Boulouis, Gregoire UNSPECIFIED orcid.org/0000-0001-8422-9205 UNSPECIFIED Soize, Sebastien UNSPECIFIED UNSPECIFIED UNSPECIFIED Maus, Volker UNSPECIFIED orcid.org/0000-0001-5097-2631 UNSPECIFIED Fischer, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Lobsien, Donald UNSPECIFIED UNSPECIFIED UNSPECIFIED Klisch, Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Styczen, Hanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Deuschl, Cornelius UNSPECIFIED UNSPECIFIED UNSPECIFIED Abdullayev, Nuran UNSPECIFIED orcid.org/0000-0003-4522-537X UNSPECIFIED Kabbasch, Christoph UNSPECIFIED orcid.org/0000-0003-3712-2258 UNSPECIFIED Kaiser, Daniel UNSPECIFIED orcid.org/0000-0001-5258-0025 UNSPECIFIED Jamous, Ala UNSPECIFIED UNSPECIFIED UNSPECIFIED Behme, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Janot, Kevin UNSPECIFIED UNSPECIFIED UNSPECIFIED Bellanger, Guillaume UNSPECIFIED UNSPECIFIED UNSPECIFIED Cognard, Cristophe UNSPECIFIED UNSPECIFIED UNSPECIFIED Pierot, Laurent UNSPECIFIED UNSPECIFIED UNSPECIFIED Gawlitza, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-601661
DOI:	10.1136/neurintsurg-2021-018188
Journal or Publication Title:	J. NeuroInterventional Surg.
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1759-8486
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PIPELINE EMBOLIZATION DEVICE; OCULOMOTOR NERVE PALSY; INTRACRANIAL ANEURYSMS; ENDOVASCULAR TREATMENT; NATURAL-HISTORY; MANAGEMENT; RECOVERY; RESOLUTION; OCCLUSION; SERIES Multiple languages Neuroimaging; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/60166