[MIRS-IR Vol III:1; 1/26/99]

Coil Embolization of an
Ophthalmic Artery Aneurysm

Valerie R. Eckard, MD, Edward L. Siegel, MD, and Donald A. Eckard, MD

Introduction
Surgical clipping of intracranial aneurysms is the most common treatment currently in use. In some cases, however, aneurysm size, location, or character can encumber surgical clipping. Endovascular embolization of these aneurysms has proven to be a valuable alternative. This technique has been advanced by the recent introduction of the Gugliemi Detachable Coil (GDC). (1)

Case Presentations
A 47 year-old female presented to our institution with a one week history of severe headache in association with nuchal rigidity. CT imaging demonstrated a subarachnoid hemorrhage and a large aneurysm in the region of the right internal carotid artery. Cerebral angiography demonstrated a large, 16 mm aneurysm arising from the right ophthalmic artery, just distal to its origin (figure 1). Because ophthalmic artery aneurysms can be difficult to treat surgically, it was decided to treat this aneurysm using GDC embolization.

Technique
The right common femoral artery was accessed and a 7 French sheath was placed. A custom-formed 5 French diagnostic catheter was advanced to the level of the aortic arch and digital subtraction angiography was performed. DSA during selective catheterization of the right internal carotid artery confirmed a large, 16 mm aneurysm arising from the ophthalmic artery, just distal to its origin. The neck of the aneurysm measured 4-5 mm diameter. The diagnostic catheter was exchanged for a 6 French introducer catheter and the tip was placed in the distal right ICA. A Turbo-Tracker 18 catheter (Target Therapeutics, Fremont, CA) with two distal tip markers was passed through the introducer catheter in a coaxial fashion and the aneurysm selectively catheterized. Eighteen GDC coils were then packed into the aneurysm. Angiography was performed intermittently during the procedure to assess for proper coil placement. At one time, the catheter was dislodged from the aneurysm. The catheter was thus repositioned in order to fill a portion of the aneurysm not adequately packed with coils. The microcatheter was then removed and DSA was performed.

Results
Arteriography immediately following the procedure demonstrated total occlusion of the aneurysm (figure 2). Intracranial branches of the right ICA, including the right ophthalmic artery were patent without evidence of thrombosis or spasm. Follow up angiography was performed after seven weeks; continued occlusion of the right ophthalmic artery aneurysm was demonstrated. The patient has been followed for approximately one year since her initial hemorrhage. She continues to do well.

Discussion
In some cases, open surgical treatment of intracranial aneurysms is complicated or prevented by aneurysm size, location or morphology. Ophthalmic artery aneurysms are frequently referred for coil placement because their location makes them difficult to clip. Endovascular intra-aneurysmal coil placement has proven to be a beneficial alternative method of treatment in many of these cases. Preliminary results with GDC coils have been promising with 85 percent of the aneurysms showing greater than 90 percent occlusion and 83 percent of patients having good recovery. This compares favorably to results from surgical clipping.