PT  - JOURNAL ARTICLE
AU  - O. Tanweer
AU  - E. Raz
AU  - A. Brunswick
AU  - D. Zumofen
AU  - M. Shapiro
AU  - H.A. Riina
AU  - M. Fouladvand
AU  - T. Becske
AU  - P.K. Nelson
TI  - Cavernous Carotid Aneurysms in the Era of Flow Diversion: A Need to Revisit Treatment Paradigms
AID  - 10.3174/ajnr.A4081
DP  - 2014 Aug 21
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2014/08/21/ajnr.A4081.short
4100  - http://www.ajnr.org/content/early/2014/08/21/ajnr.A4081.full
AB  - BACKGROUND AND PURPOSE: Recent techniques of endoluminal reconstruction with flow-diverting stents have not been incorporated into treatment algorithms for cavernous carotid aneurysms. This study examines the authors’ institutional experience and a systematic review of the literature for outcomes and complications using the Pipeline Embolization Device in unruptured cavernous carotid aneurysms. MATERIALS AND METHODS: A retrospective search for cavernous carotid aneurysms from a prospectively collected data base of aneurysms treated with the Pipeline Embolization Device at our institution was performed. Baseline demographic, clinical, and laboratory values; intrainterventional data; and data at all follow-up visits were collected. A systematic review of the literature for complication data was performed with inquiries sent when clarification of data was needed. RESULTS: Forty-three cavernous carotid aneurysms were included in the study. Our mean radiographic follow-up was 2.05 years. On last follow-up, 88.4% of the aneurysms treated had complete or near-complete occlusion. Aneurysm complete or near-complete occlusion rates at 6 months, 12 months, and 36 months were 81.4%, 89.7%, and 100%, respectively. Of patients with neuro-ophthalmologic deficits on presentation, 84.2% had improvement in their visual symptoms. Overall, we had a 0% mortality rate and a 2.3% major neurologic complication rate. Our systematic review of the literature yielded 227 cavernous carotid aneurysms treated with the Pipeline Embolization Device with mortality and morbidity rates of 0.4% and 3.1%, respectively. CONCLUSIONS: Endoluminal reconstruction with flow diversion for large unruptured cavernous carotid aneurysms can yield high efficacy with low complications. Further long-term data will be helpful in assessing the durability of the cure; however, we advocate a revisiting of current management paradigms for cavernous carotid aneurysms. Abbreviations CCAcavernous carotid aneurysmPEDPipeline Embolization Device