Mid- and Long-Term Outcomes Following Flow Diversion for Carotid-Ophthalmic Aneurysms: a Single-Centre Experience

Flow diverter stents (FDS) have shown promise in treating carotid-ophthalmic aneurysms (COAs), but mid- to long-term data remain limited. This study reports our institutional experience using FDS for unruptured COAs.

Between August 2010 and September 2023, 105 unruptured COAs in 99 patients (87 females, mean age 54 ± 14 years) were retrospectively analyzed. The anatomical relationship between the ophthalmic artery (OphA) and the aneurysm was classified as Type 1 (separate), Type 2 (neck), or Type 3 (dome). Patients were treated with FDS alone or with adjunctive coiling. Clinical and angiographic outcomes, including visual complications, were assessed.

Technical success was 98.1%. At a mean follow-up of 38.5 months, complete occlusion was achieved in 89.1% and adequate occlusion in 98.0%. Occlusion rates were comparable across types, with a trend toward lower rates in Type 2. Retreatment was required in 1.0%. Major adverse events occurred in 1.0%, neurological complications in 3.0%, and in-stent stenosis in 2.0%. New visual deficits occurred in 6.1% (4.0% transient, 2.0% permanent). Aneurysm size > 12 mm was significantly associated with persistent symptoms (p = 0.003). Preoperative visual symptoms were the only independent predictor of poor visual outcome. Outcomes were comparable between FDS-only and FDS+coiling groups.

FDS, with or without coiling, is a safe and effective treatment for COAs, achieving durable occlusion and generally favorable visual outcomes. The OphA-aneurysm relationship may influence occlusion, although residual filling may also reflect physiological flow preservation. Early treatment is essential in patients with large aneurysms and visual symptoms.