Visual symptoms after flow-diverter stenting of internal carotid artery aneurysms: A retrospective cohort study

Visual field defect and visual impairment are important but poorly characterized complications after flow-diverter (FD) stent placement for internal carotid artery (ICA) aneurysms.

We retrospectively analyzed 31 consecutive patients with 32 ICA aneurysms treated by FD stent implantation between October 2015 and April 2021. Aneurysms were classified into two groups those with visual symptoms before and after FD stenting (symptomatic group) and those without (asymptomatic group). We analyzed patients' background characteristics, treatment details, and imaging findings.

Visual symptoms were present in 25% (8/32) of aneurysms and worsened after treatment in 9.4% (3/32). Aneurysm enlargement was more common in the symptomatic group than the asymptomatic group (50% vs. 4.1%; odds ratio 23.0, 95% confidence interval [CI] 2.0-262.6, P = 0.0086). Poor visualization of the ophthalmic artery after procedure was observed in 50% versus 12.5% (odds ratio 7.0, 95% confidence interval 1.1-44.1, P = 0.047). No central retinal artery occlusion or cerebral ischemic events were observed. All three deteriorating cases improved after high dose steroids: one required additional FD stenting.

In this single-center retrospective cohort, visual symptoms after FD stenting were relatively common but were usually reversible. Aneurysm enlargement and early loss of ophthalmic-artery flow identify patients at higher visual risk. Early steroid therapy and, when necessary, further endovascular treatment may mitigate visual deterioration.