Acute retinal hemorrhage after Pipeline embolization device placement for treatment of ophthalmic segment aneurysm: A case report

Abstract

Introduction

Ophthalmic segment aneurysms may present with visual symptoms due to direct compression of the optic nerve. Treatment of these aneurysms with the Pipeline embolization device (PED) often results in visual improvement. Flow diversion, however, has also been associated with occlusion of the ophthalmic artery and visual deficits in a small subset of cases.

Case report

A 49-year-old Caucasian female presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. On follow-up imaging, the patient was found to have a right asymptomatic ophthalmic segment aneurysm. Due to the irregular shape of the aneurysm and history of aneurysmal subarachnoid hemorrhage, the decision was made to treat the aneurysm with a PED. Postoperatively, the patient complained of floaters in the right eye. Detailed ophthalmologic examination showed retinal hemorrhage and cotton-wool spots on the macula. Such complication after PED placement has never been reported in the literature.

Conclusion

Visual complications after PED placement for treatment of ophthalmic segment aneurysms are rare. It is thought that even in cases where the ophthalmic artery occludes, patients remain asymptomatic due to the rich collateral supply from the external carotid artery branches. Here we report a patient who developed an acute retinal hemorrhage after PED placement.

Keywords

Pipeline flow diversion visual complications retinal hemorrhage

Get full access to this article

View all access options for this article.

References

Gross

. Microsurgical treatment of ophthalmic segment aneurysms. J Clin Neurosci 2013; 20: 1145–1148.

Chalouhi

Tjoumakaris

Starke

et al.

Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke 2013; 44: 2150–2154.

Griessenauer

Ogilvy

Foreman

et al.

Pipeline embolization device for small paraophthalmic artery aneurysms with an emphasis on the anatomical relationship of ophthalmic artery origin and aneurysm. J Neurosurg 2016; 125: 1352–1359.

Lanzino

Crobeddu

Cloft

et al.

Efficacy and safety of flow diversion for paraclinoid aneurysms: a matched-pair analysis compared with standard endovascular approaches. AJNR Am J Neuroradiol 2012; 33: 2158–2161.

Sahlein

Fouladvand

Becske

et al.

Neuroophthalmological outcomes associated with use of the pipeline embolization device: analysis of the PUFS trial results. J Neurosurg 2015; 123: 897–905.

Zanaty

Chalouhi

Barros

et al.

Flow-diversion for ophthalmic segment aneurysms. Neurosurgery 2015; 76: 286–289. discussion 289–290.

Puffer

Kallmes

Cloft

et al.

Patency of the ophthalmic artery after flow diversion treatment of paraclinoid aneurysms. J Neurosurg 2012; 116: 892–896.

Skukalek

Winkler

Kang

et al.

Effect of antiplatelet therapy and platelet function testing on hemorrhagic and thrombotic complications in patients with cerebral aneurysms treated with the pipeline embolization device: a review and meta-analysis. J Neurointerv Surg 2016; 8: 58–65.

Krishna

Sonig

Natarajan

et al.

The expanding realm of endovascular neurosurgery: flow diversion for cerebral aneurysm management. Methodist DeBakey Cardiovasc J 2014; 10: 214–219.

10.

Adeeb

Griessenauer

Foreman

et al.

Comparison of stent-assisted coil embolization and pipeline embolization device for endovascular treatment of ophthalmic segment aneurysms: a multicenter cohort study. World Neurosurg 2017; 105: 206–212.

11.

Rouchaud

Leclerc

Benayoun

et al.

Visual outcomes with flow-diverter stents covering the ophthalmic artery for treatment of internal carotid artery aneurysms. AJNR Am J Neuroradiol 2015; 36: 330–336.