O22 Flow diversion versus intra-saccular flow disruption techniques for the treatment of unruptured carotid ophthalmic aneurysms

<h3>Introduction</h3> Intra-saccular flow disruptors (ISFD) have not yet been routinely used for internal carotid artery (ICA) para-ophthalmic aneurysms. However, flow diverter stents (FDS) have been considered the first-line treatment of these aneurysms with optimal occlusion rates. <h3>Aim of Study</h3> This single-center study aims to assess the safety and efficacy of ISFD compared to FDS for para-ophthalmic aneurysm treatment. <h3>Methods</h3> We retrospectively reviewed consecutive patients with para-ophthalmic aneurysms treated with either ISFD or FDS at our institution from January 2011 to March 2023. We collected demographics, technical success, complication rates, and angiographic outcomes. <h3>Results</h3> We identified 46 patients (median age: 50.4) with 51 unruptured saccular ICA para-ophthalmic aneurysms. The mean aneurysm size was 6.2 mm, including 55% of wide-necked lesions (neck size &gt;4mm). The treatments included WEB or CONTOUR devices in 17 cases and FDS in 34 cases. At the latest follow-up (FU) available, aneurysms treated by FDS demonstrated adequate occlusion (defined as complete occlusion or presence of a neck remnant) in 92.9% (mean FU time 59 months). Those treated with ISFD showed comparable results, with 94.1% (p=0.8) achieving adequate occlusion (mean FU 26 months). Thromboembolic events occurred in 5.8% of patients in each group. No mortality was observed, one patient in the FDS group experienced permanent morbidity following parenchymal hematoma (hemiparesis and aphasia). <h3>Conclusion</h3> ISFD offers a safe and effective alternative for FDS in para-ophthalmic aneurysm treatment. Its benefits include reduced peri-operative anti-platelet administration with potential application in emergency settings.