Improvement in Visual Symptomatology after Endovascular Treatment of Cavernous Carotid Aneurysms

Abstract

Introduction: Aneurysms arising from the cavernous internal carotid artery (CCAs) pose technical challenges for surgical management and such patients are frequently referred for endovascular treatment. These
aneurysms often produce a variety of neurological deficits, primarily those related to oculoparesis. Our purpose was to determine the visual and neurological outcome of patients with treated CCAs.
Methods: We reviewed the medical records and angiograms for patients who underwent endovascular
treatment for CCAs at three academic medical centers. The following outcomes were analyzed: angiographic assessment, visual improvement and outcome at 3 months using Glasgow Outcome Scale (GOS).
Results: Thirty-four patients (mean age 54.7 years) were treated for CCAs. The mean aneurysm size was
14.2 mm (range: 3-45 mm), and fourteen patients (41.2%) required stent assistance. Twenty-one aneurysms
(61.8%) were completely occluded; nine aneurysms (26.6%) had near-complete occlusion; 4 aneurysms
(11.8%) had partial occlusion. Seven patients (20.6%) required retreatment. Fifteen of the 34 patients
(44.1%) presented with visual symptoms, while only eight patients had residual visual symptomatology at
follow-up (44.1% vs. 23.5%; p=0.02). Patients that presented with visual symptoms (N=15) had a mean
aneurysm size of 24.5 mm, while those without visual symptoms (N=19) had a size of 7.5 mm (p=0.001).
Follow-up GOS was good (4-5) in 29 patients (90.6%). No thromboembolic complications were observed.
One patient died (3.1%) of an unrelated cause.
Conclusions: Most patients in this multicenter series improved or remained stable after treatment. The
results of this study indicate that endovascular treatment may improve the outcome of visual symptoms in
patients with large cavernous aneurysms with low periprocedural morbidity.