Endovascular treatment of unruptured cavernous carotid aneurysms using flow diverter devices in Vietnam: A single-center prospective study

Objective: This prospective study aims to investigate the safety and effectiveness of flow diverter (FD) in the treatment of unruptured cavernous carotid aneurysms (CCAs) in Vietnam. Methods: A single-center, prospective case series of 32 patients with unruptured CCAs treated by FD at our center from January 2017 to January 2022 was performed. We analyzed the aneurysm characteristics, procedure details, aneurysm occlusion rate, evolution of clinical symptoms, complications, and functional outcomes after treatment. Angiographic study was scheduled at the 6-month and 12-month follow-up. The occlusion rate was evaluated according to the O’Kelly-Marotta (OKM) Scale. Results: 35 FDs were deployed to treat 32 unruptured CCAs in 32 patients (mean age, 59.25; mean aneurysm size, 12.13 mm). Stent implantation was successful in all patients. Single FD was used in 29 cases (90.6%). Adjunctive coils were placed in five patients (15.6%). Complete aneurysm occlusion was achieved in 61.3% at 6 months and 96.4% at 12 months. Favorable outcome defined as mRS 0–2 was reported in all except one patient. Complete resolution or significant improvement of clinical symptoms was noted in 29 of 30 symptomatic patients (96.7%). Periprocedural complications included vessel perforation with severe SAH leading to death in one case (3.1%), minor vasospasm in four (12.5%), acute in-stent thrombosis in two (6.3%), and puncture-related hematoma in two (6.3%). All of these patients were successfully managed without clinical sequalae after the procedure except for one case. Conclusion: FD represents a safe and effective treatment modality that might be considered as a valuable alternative to standard endovascular coiling techniques or carotid sacrifice for unruptured CCAs.