Ruptured carotid artery aneurysms of the ophthalmic (C6) segment: clinical and angiographic long-term follow-up of a multidisciplinary management strategy
Abstract
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 embolization 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 embolization 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%) embolization, 3 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±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±47.6 months) showed 73.4% of the population reaching GOS 4-5, this data being equivalent to the ISAT outcomes.
Conclusions: Based on favorable neuroradiologic and ophthalmologic 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, embolization can be recommended for inferiorly/medially projecting small, narrow necked aneurysms.
