Endovascular treatment of carotid cavernous aneurysms: Complications, outcomes and comparison of interventional strategies

Robert M. Starke, Nohra Chalouhi, Muhammad S. Ali, Stavropoula I. Tjoumakaris, Pascal M. Jabbour, L. Fernando Gonzalez, Robert H. Rosenwasser, Aaron S. Dumont

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

The best treatment modality for cavernous carotid aneurysms (CCA) remains unclear. We treated 82 CCA in 79 patients with endovascular coiling (n = 14), stent assistance (n = 53), and carotid vessel deconstruction (CVD) (n = 15). Favorable outcomes were defined as a Glasgow Outcome Scale of 4 to 5 without worsening signs or symptoms. Mean CCA size was 13.3 ± 9.2 mm, and CCA treated with CVD were larger (p = 0.010). Fourteen patients had incidental CCA, 40 (50.6%) had cranial nerve palsies (CNP), and 25 (31.7%) had pain leading to diagnosis. Immediate occlusion (>95%) occurred in 91.5% of aneurysms. Ischemic or hemorrhagic complications developed following eight treatments (9.8%) and three were permanent (3.7%). There were no deaths, and favorable discharge outcome occurred following 87.8% of procedures. Although there was no difference in immediate occlusion or complications amongst treatment cohorts, fewer permanent complications (0% versus 10.3%, p = 0.041) and favorable discharge outcomes (p = 0.039) were associated with stent assisted treatment. Follow-up was available following 75 procedures (mean 21.4 ± 17.4 months). Recanalization occurred in 36% of patients and retreatment in 25%. Patients presenting with CNP improved over time (p < 0.001); 54% of patients presenting with CNP remained unchanged while 46% improved; there was no difference in improvement rates stratified by treatment. Favorable follow-up outcome occurred after 96% of treatments and those receiving stents were more likely to have favorable outcome in multivariate analysis (p = 0.039). Endovascular therapy is a safe and effective therapy for CCA. When possible, stent assisted therapy may be the best option with fewer complications and low recanalization rates.

Original languageEnglish (US)
Pages (from-to)40-46
Number of pages7
JournalJournal of Clinical Neuroscience
Volume21
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

Keywords

  • Aneurysm
  • Cavernous
  • Embolization
  • Flow diversion
  • Stent
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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