Endovascular treatment of an unruptured ophthalmic artery aneurysm with a flow diverter: a case report

  • Rakhmad Hidayat Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0003-4615-5246
  • Fadila Asmaniar Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Affan Priambodo Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-8685-2172
  • Taufik Mesiano Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-9021-7841
  • Muhammad Kurniawan Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Al Rasyid Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Salim Harris Department of Neurology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Keywords: aneurysm, computed tomography angiography, digital subtraction angiography, endovascular, ophthalmic artery, seizures
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Abstract

An unruptured aneurysm is often asymptomatic or present without neurological deficits, causing severe morbidity. However, the potential of this defect to rupture requires proper management. Herein, we report a case of an unruptured saccular aneurysm of the ophthalmic artery with initial clinical seizures. The patient was treated by flow diversion which redirects the blood flow that normally leads to the protrusion of the aneurysm back to the main vessel. Flow diversion is chosen because it is less risky and has a faster recovery time than other treatment options, but it is more expensive than others. Although this technology is not new, there is no report on its implementation in Indonesia. The patient was prescribed antiplatelet treatment for at least 6 months post-treatment, then she showed no sign of seizure or new focal neurological deficits 4 months post-treatment. The patients were expected to undergo digital subtraction angiography evaluation 6 months after flow diversion treatment, but it has not been performed due to the coronavirus disease 2019 pandemic.

References

  1. Feigin VL, Norriving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439-48. https://doi.org/10.1161/CIRCRESAHA.116.308413

  2. Ministry of Health of The Republic of Indonesia. Basic Health Research (RISKESDAS) 2018. Ministry of Health of the Republic of Indonesia: National Institute of Health Research and Development; 2018. Indonesian.

  3. Date I. Symptomatic unruptured cerebral aneurysms: features and surgical outcome. Neurol Med Chir (Tokyo). 2010;50(9):788-99. https://doi.org/10.2176/nmc.50.788

  4. Thompson BG, Brown RD Jr, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(8):2368-400. https://doi.org/10.1161/STR.0000000000000070

  5. Moon K, Albuquerque FC, Ducruet AF, Crowley RW, McDougall CG. Treatment of ophthalmic segment carotid aneurysms using the pipeline embolization device: clinical and angiographic follow-up. Neurol Res. 2014;36(4):344-50. https://doi.org/10.1179/1743132814Y.0000000322

  6. Zhao L, Wang R, Song B, Tan S, Gao Y, Fang H, et al. Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke. Int J Stroke. 2015;10(5):752-8. https://doi.org/10.1111/ijs.12471

  7. Sellar R. Complications of interventional treatment of cerebral aneurysms. Interv Neuroradiol. 2008;14(Suppl 1):63-74. https://doi.org/10.1177/15910199080140S112

  8. Sena JC, Reynier Y, Alliez B. Unruptured intracranial aneurysm presenting with epiletic seizure. Arq Neuropsiquiatr. 2003;61(3-A):663-7. https://doi.org/10.1590/S0004-282X2003000400026

  9. Kamali AW, Cockerell OC, Butlar P. Aneurysms and epilepsy: an increasingly recognised cause. Seizure. 2004;13(1):40-4. https://doi.org/10.1016/S1059-1311(03)00075-X

  10. Zanaty M, Chalouhi N, Barros G, Schwartz EW, Saigh MP, Starke RM, et al. Flow-diversion for ophthalmic segment aneurysms. Neurosurgery. 2015;76(3):286-9; discussion 289-90. https://doi.org/10.1227/NEU.0000000000000607

  11. Rangel-Castilla L, Nakaji P, Siddiqui AH, Spetzler RF, Levy EI, editors. Decision making in neurovascular disease [Internet]. Stuttgart: Thieme Verlagsgruppe; 2018 [cited Jul 17 2020].Available from: http://www.thieme-connect.de/products/ebooks/book/10.1055/b-006-160136. https://doi.org/10.1055/b-0038-162129

  12. Alderazi YJ, Shastri D, Kass-Hout T, Prestigiacomo CJ, Gandhi CD. Flow diverters for intracranial aneurysms. Stroke Res Treat. 2014;2014: 415653. https://doi.org/10.1155/2014/415653

  13. Dholakia R, Sadasivan C, Fiorella DJ, Woo HH, Lieber BB. Hemodynamics of flow diverters. J Biomech Eng. 2017;139(2). https://doi.org/10.1115/1.4034932

  14. Burrows AM, Brinjikji W, Puffer RC, Cloft H, Kallmes DF, Lanzino G. Flow diversion for ophthalmic artery aneurysms. Am J Neuroradiol. 2016;37(10):1866-9. https://doi.org/10.3174/ajnr.A4835

  15. Tonetti DA, Jankowitz BT, Gross BA. Antiplatelet therapy in flow diversion. Neurosurgery. 2020;86(Suppl 1):S47-52. https://doi.org/10.1093/neuros/nyz391

Published
2021-06-04
How to Cite
1.
Hidayat R, Asmaniar F, Priambodo A, Mesiano T, Kurniawan M, Rasyid A, Harris S. Endovascular treatment of an unruptured ophthalmic artery aneurysm with a flow diverter: a case report. Med J Indones [Internet]. 2021Jun.4 [cited 2021Nov.27];1(1). Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/4899
Section
Case Report/Series