Ruptured carotid artery aneurysms of the ophthalmic (C6) segment: clinical and angiographic long term follow-up of a multidisciplinary management strategy

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 80; no. 11; pp. 1261 - 1267
• Main Authors: Sherif, C, Gruber, A, Dorfer, C, Bavinzski, G, Standhardt, H, Knosp, E
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.11.2009; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Aneurysm, Ruptured - classification; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - surgery; Aneurysms; Balloon Occlusion; Biological and medical sciences; Calcification; Carotid arteries; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - surgery; Carotid Artery Diseases - therapy; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - surgery; Cerebral Angiography; Embolization; Embolization, Therapeutic - adverse effects; Female; Follow-Up Studies; Glasgow Outcome Scale; Humans; Hydrocephalus; Male; Medical imaging; Medical sciences; Microsurgery - adverse effects; Microsurgery - methods; Middle Aged; Models, Cardiovascular; Neurology; Ophthalmic Artery; Patient Care Team; Patients; Postoperative Complications - diagnostic imaging; Retreatment - statistics & numerical data; Statistical analysis; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Veins & arteries; United States > US; Ophthalmic artery; Nervous system diseases; Clinical management; Angiography; Blood vessel; Carotid; Strategy; Circulatory system; Long term; Artery aneurysm; CEREBROVASCULAR; SUBARACHNOID HAEMORRHAGE; INTERVENTIONAL; NEUROSURGERY
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2008.170860

Background:The management of ruptured C6 aneurysms remains controversial. Detailed long-term outcome data are still lacking. Thus the present study provided a detailed long term follow-up for a multidisciplinary approach combining microsurgical clipping, endovascular embolisation and parent artery occlusion with/without bypass protection.Methods:In our single centre analysis of 64 consecutive patients, indications for microsurgery were: superior aneurysm projection, giant/large or wide necked aneurysms and aneurysms at branching sites. Indications for embolisation were: narrow necks, neck calcification, close aneurysm relation to the clinoid process or adhesion to the distal dural ring, and aneurysm location in the concavity of the carotid siphon curve.Results:23 patients (35.9%) underwent microsurgery, 38 patients (59.4%) embolisation and three patients (4.7%) parent artery occlusion under bypass protection. Retreatment was required in 20.9% (surgery 8.7%, endovascular 31.6%). Procedure related transient complications occurred in 10.9% (surgery 13.0%, endovascular 10.5%). Procedure related permanent morbidities occurred in 6.3% (surgery 8.7%, endovascular 5.3%), including visual deficits in 4.7% (surgery 4.4%, endovascular 5.3%). One endovascular patient died. Angiographic follow-up (29.2 (SD 31.9) months) revealed total aneurysm occlusion in 94.4% of the surgical and 82.9% of the endovascular patients. Clinical follow-up (58.7 (SD 47.6) months) showed 73.4% of the population reaching Glasgow Outcome Scale 4–5, these data being equivalent to the International Subarachnoid Aneurysm Trial (ISAT) outcomes.Conclusions:Based on favourable neuroradiological and ophthalmological outcomes, microsurgery is recommended for superiorly projecting aneurysms, especially aneurysms involving the ophthalmic artery, and for giant/large or wide necked aneurysms. Based on stable aneurysm occlusion and excellent clinical outcomes, embolisation can be recommended for inferiorly/medially projecting small, narrow necked aneurysms.