Published in November 9, 2023
Left Ophthalmic aneurysms with ipsilateral ICA dissection

Case Review


• 47-year-old male.
• Chief complaint: left eye pain and left ptosis for 1 month.
• History: no HBP or DM. Smoking.
• NE: ptosis of the left side.

Video 1. Angiography shows two ophthalmic artery aneurysms with ipsilateral ICA dissection. One of the ophthalmic aneurysm is on the course of oculomotor nerve. 

Figure 1. Ptosis was due to the left oculomotor nerve comspanssed by the aneurysm. 



  1. Two aneurysms located at the ophthalmic segment of the left ICA.

  • Stent-assisted coiling – it may be difficult to embolize the second aneurysm after stent deployment.
  • FD stent can simplify the procedure.

2.The ICA dissection can be treated with carotid stent implantation. During the procedure, the guiding catheter should be first navigated into the cavernous segment of the ICA for FD deployment. Then retrieve the guiding catheter and deploy the carotid stent.



Figure 2. General Heparinization was administrated at the beginning of the operation. 

Figure 3 GIF. 6F 90cm sheath. 6F 115cm Navien was placed at the cavernous segment of the left ICA. 

Figure 4 GIF. Marksman microcatheter was navigated to the left M1 guided by Synchro II standard microwire. 

Video 2. Pipeline 4.0*20mm was deployed covering two ophthalmic artery aneurysms. 

Video 3. The stent was fully deployed, and in-stent massage was performed by the microcatheter. 

Figure 5 GIF. Precise 6*40mm stent was deployed for remodeling the dissecting segment of the left ICA. 

Figure 6 GIF. Post-operation angiography shows the contrast medium retention in the aneurysm sac and the dissection. 

Figure 7 GIF. 3D reconstruction shows the well-deployment of the Pipeline stent. 

Figure 8. Post-operative Dyna CT shows no intracranial hemorrhage or infraction. 



• No new neurologic deficit.

• PE: left side ptosis.
• Medication: Clopidogrel 75mg qd, Aspirin 100mg qd, Atorvastatin 20mg qN.


Follow up

3-month follow up 

• Left side ptosis was recovered 2-month post operation.

• Dual antiplatelet therapy was used for one month.

• Therapy was stopped by the patient himself.

Figure 9 GIF. 3-month follow up angiography shows the complete occlusion of two ophthalmic artery aneurysms with patent parent artery and mild stenosis proximal to the dissection.

Clinical recommendation for follow up and medication 
• Aspirin was spanscribed for long-term.
• One-year DSA follow up is suggested.



• In the case with two ophthalmic artery aneurysms, flow divert treatment is recommended for simplifying the procedure, which is also beneficial to oculomotor nerve palsy recovery.

• 6F sheath and 6F 115cm Navien can supply better support and make it easier to deploy the FD stent.
• For the ICA dissection, navigate the guiding catheter to the distal part of the ICA before deploying the carotid stent is recommended.
• Precise stent is reliable and safe to treat cervical segment dissection aneurysm.
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