NANOSNET

Good afternoon all,

I have a patient with history of right-sided posterior communicating aneurysm who initially underwent coil embolization and subsequently had pipeline embolization (flow diverter) 1 month later (11/14/24). She had angiogram 5/22/25 which showed no evidence of filling of the previously embolized right posterior communicating artery aneurysm and no evidence of stent complication. She was switched at that time from Brilinta to ASA 81 mg. She is on Eliquis for lower extremity DVT that developed after a 13 hour car ride following her hospital admission.

On 5/31/25 she developed acute loss of vision in the right eye and has now had 8 episodes.   7 of the 8 occurred related to daylight (7 when going from indoors out into the sun and 1 while driving into the sun) and 1 when she woke up in the morning.  All have been essentially the same lasting about 15 minutes before abating.  Sudden onset and cessation with no other neurologic symptoms at the same time. MRI shows nothing changed from previous with stent in close contact with right optic tract (not optic nerve).  I asked the surgeon about this, and he said:

"The stent is not a normal stent, rather a flow diverter (changes the flow across the segment) so in her case it's in the communicating segment and it covers the ophthalmic artery. It's very commonly used. There are case reports on retinal ischemia following flow diversion, but not common. Once the stent is in and endothelialized ( which happens 4-6 weeks after placement), we can't take it out. "

Anyone have any experience with this situation?  Ideas on treatment? Her exam while asymptomatic is totally normal as is her VF and OCT.

Thanks in advance for any help you can provide

ELB

Eric L. Berman, MD

Dr. William A. and Sandra F. Johnson Endowed Chair in Neuro-Ophthalmology

Director, Neuro-Ophthalmology Service

Storm Eye Institute

Medical University of South Carolina

Good afternoon all,

I have a patient with history of right-sided posterior communicating aneurysm who initially underwent coil embolization and subsequently had pipeline embolization (flow diverter) 1 month later (11/14/24). She had angiogram 5/22/25 which showed no evidence of filling of the previously embolized right posterior communicating artery aneurysm and no evidence of stent complication. She was switched at that time from Brilinta to ASA 81 mg. She is on Eliquis for lower extremity DVT that developed after a 13 hour car ride following her hospital admission.

On 5/31/25 she developed acute loss of vision in the right eye and has now had 8 episodes.   7 of the 8 occurred related to daylight (7 when going from indoors out into the sun and 1 while driving into the sun) and 1 when she woke up in the morning.  All have been essentially the same lasting about 15 minutes before abating.  Sudden onset and cessation with no other neurologic symptoms at the same time. MRI shows nothing changed from previous with stent in close contact with right optic tract (not optic nerve).  I asked the surgeon about this, and he said:

"The stent is not a normal stent, rather a flow diverter (changes the flow across the segment) so in her case it's in the communicating segment and it covers the ophthalmic artery. It's very commonly used. There are case reports on retinal ischemia following flow diversion, but not common. Once the stent is in and endothelialized ( which happens 4-6 weeks after placement), we can't take it out. "

Anyone have any experience with this situation?  Ideas on treatment? Her exam while asymptomatic is totally normal as is her VF and OCT.

Thanks in advance for any help you can provide

ELB

Eric L. Berman, MD

Dr. William A. and Sandra F. Johnson Endowed Chair in Neuro-Ophthalmology

Director, Neuro-Ophthalmology Service

Storm Eye Institute

Medical University of South Carolina

If there is no contraindication, I suggest a calcium channel blocker if vasospasm is suspected (e.g., verapamil).

Deb

Good afternoon all,

I have a patient with history of right-sided posterior communicating aneurysm who initially underwent coil embolization and subsequently had pipeline embolization (flow diverter) 1 month later (11/14/24). She had angiogram 5/22/25 which showed no evidence of filling of the previously embolized right posterior communicating artery aneurysm and no evidence of stent complication. She was switched at that time from Brilinta to ASA 81 mg. She is on Eliquis for lower extremity DVT that developed after a 13 hour car ride following her hospital admission.

On 5/31/25 she developed acute loss of vision in the right eye and has now had 8 episodes.   7 of the 8 occurred related to daylight (7 when going from indoors out into the sun and 1 while driving into the sun) and 1 when she woke up in the morning.  All have been essentially the same lasting about 15 minutes before abating.  Sudden onset and cessation with no other neurologic symptoms at the same time. MRI shows nothing changed from previous with stent in close contact with right optic tract (not optic nerve).  I asked the surgeon about this, and he said:

"The stent is not a normal stent, rather a flow diverter (changes the flow across the segment) so in her case it's in the communicating segment and it covers the ophthalmic artery. It's very commonly used. There are case reports on retinal ischemia following flow diversion, but not common. Once the stent is in and endothelialized ( which happens 4-6 weeks after placement), we can't take it out. "

Anyone have any experience with this situation?  Ideas on treatment? Her exam while asymptomatic is totally normal as is her VF and OCT.

Thanks in advance for any help you can provide

ELB

Eric L. Berman, MD

Dr. William A. and Sandra F. Johnson Endowed Chair in Neuro-Ophthalmology

Director, Neuro-Ophthalmology Service

Storm Eye Institute

Medical University of South Carolina

Thank you both – I have already suggested verapamil as a 1^st treatment.

ELB

If there is no contraindication, I suggest a calcium channel blocker if vasospasm is suspected (e.g., verapamil).

Deb

Good afternoon all,

I have a patient with history of right-sided posterior communicating aneurysm who initially underwent coil embolization and subsequently had pipeline embolization (flow diverter) 1 month later (11/14/24). She had angiogram 5/22/25 which showed no evidence of filling of the previously embolized right posterior communicating artery aneurysm and no evidence of stent complication. She was switched at that time from Brilinta to ASA 81 mg. She is on Eliquis for lower extremity DVT that developed after a 13 hour car ride following her hospital admission.

On 5/31/25 she developed acute loss of vision in the right eye and has now had 8 episodes.   7 of the 8 occurred related to daylight (7 when going from indoors out into the sun and 1 while driving into the sun) and 1 when she woke up in the morning.  All have been essentially the same lasting about 15 minutes before abating.  Sudden onset and cessation with no other neurologic symptoms at the same time. MRI shows nothing changed from previous with stent in close contact with right optic tract (not optic nerve).  I asked the surgeon about this, and he said:

"The stent is not a normal stent, rather a flow diverter (changes the flow across the segment) so in her case it's in the communicating segment and it covers the ophthalmic artery. It's very commonly used. There are case reports on retinal ischemia following flow diversion, but not common. Once the stent is in and endothelialized ( which happens 4-6 weeks after placement), we can't take it out. "

Anyone have any experience with this situation?  Ideas on treatment? Her exam while asymptomatic is totally normal as is her VF and OCT.

Thanks in advance for any help you can provide

ELB

Eric L. Berman, MD

Dr. William A. and Sandra F. Johnson Endowed Chair in Neuro-Ophthalmology

Director, Neuro-Ophthalmology Service

Storm Eye Institute

Medical University of South Carolina

Thank you both – I have already suggested verapamil as a 1^st treatment.

ELB

If there is no contraindication, I suggest a calcium channel blocker if vasospasm is suspected (e.g., verapamil).

Deb

Good afternoon all,

I have a patient with history of right-sided posterior communicating aneurysm who initially underwent coil embolization and subsequently had pipeline embolization (flow diverter) 1 month later (11/14/24). She had angiogram 5/22/25 which showed no evidence of filling of the previously embolized right posterior communicating artery aneurysm and no evidence of stent complication. She was switched at that time from Brilinta to ASA 81 mg. She is on Eliquis for lower extremity DVT that developed after a 13 hour car ride following her hospital admission.

On 5/31/25 she developed acute loss of vision in the right eye and has now had 8 episodes.   7 of the 8 occurred related to daylight (7 when going from indoors out into the sun and 1 while driving into the sun) and 1 when she woke up in the morning.  All have been essentially the same lasting about 15 minutes before abating.  Sudden onset and cessation with no other neurologic symptoms at the same time. MRI shows nothing changed from previous with stent in close contact with right optic tract (not optic nerve).  I asked the surgeon about this, and he said:

"The stent is not a normal stent, rather a flow diverter (changes the flow across the segment) so in her case it's in the communicating segment and it covers the ophthalmic artery. It's very commonly used. There are case reports on retinal ischemia following flow diversion, but not common. Once the stent is in and endothelialized ( which happens 4-6 weeks after placement), we can't take it out. "

Anyone have any experience with this situation?  Ideas on treatment? Her exam while asymptomatic is totally normal as is her VF and OCT.

Thanks in advance for any help you can provide

ELB

Eric L. Berman, MD

Dr. William A. and Sandra F. Johnson Endowed Chair in Neuro-Ophthalmology

Director, Neuro-Ophthalmology Service

Storm Eye Institute

Medical University of South Carolina

ELB

Thank you both – I have already suggested verapamil as a 1^st treatment.

ELB

If there is no contraindication, I suggest a calcium channel blocker if vasospasm is suspected (e.g., verapamil).

Deb

Good afternoon all,

I have a patient with history of right-sided posterior communicating aneurysm who initially underwent coil embolization and subsequently had pipeline embolization (flow diverter) 1 month later (11/14/24). She had angiogram 5/22/25 which showed no evidence of filling of the previously embolized right posterior communicating artery aneurysm and no evidence of stent complication. She was switched at that time from Brilinta to ASA 81 mg. She is on Eliquis for lower extremity DVT that developed after a 13 hour car ride following her hospital admission.

On 5/31/25 she developed acute loss of vision in the right eye and has now had 8 episodes.   7 of the 8 occurred related to daylight (7 when going from indoors out into the sun and 1 while driving into the sun) and 1 when she woke up in the morning.  All have been essentially the same lasting about 15 minutes before abating.  Sudden onset and cessation with no other neurologic symptoms at the same time. MRI shows nothing changed from previous with stent in close contact with right optic tract (not optic nerve).  I asked the surgeon about this, and he said:

"The stent is not a normal stent, rather a flow diverter (changes the flow across the segment) so in her case it's in the communicating segment and it covers the ophthalmic artery. It's very commonly used. There are case reports on retinal ischemia following flow diversion, but not common. Once the stent is in and endothelialized ( which happens 4-6 weeks after placement), we can't take it out. "

Anyone have any experience with this situation?  Ideas on treatment? Her exam while asymptomatic is totally normal as is her VF and OCT.

Thanks in advance for any help you can provide

ELB

Eric L. Berman, MD

Dr. William A. and Sandra F. Johnson Endowed Chair in Neuro-Ophthalmology

Director, Neuro-Ophthalmology Service

Storm Eye Institute

Medical University of South Carolina

ELB

Thank you both – I have already suggested verapamil as a 1^st treatment.

ELB

If there is no contraindication, I suggest a calcium channel blocker if vasospasm is suspected (e.g., verapamil).

Deb

Good afternoon all,

I have a patient with history of right-sided posterior communicating aneurysm who initially underwent coil embolization and subsequently had pipeline embolization (flow diverter) 1 month later (11/14/24). She had angiogram 5/22/25 which showed no evidence of filling of the previously embolized right posterior communicating artery aneurysm and no evidence of stent complication. She was switched at that time from Brilinta to ASA 81 mg. She is on Eliquis for lower extremity DVT that developed after a 13 hour car ride following her hospital admission.

On 5/31/25 she developed acute loss of vision in the right eye and has now had 8 episodes.   7 of the 8 occurred related to daylight (7 when going from indoors out into the sun and 1 while driving into the sun) and 1 when she woke up in the morning.  All have been essentially the same lasting about 15 minutes before abating.  Sudden onset and cessation with no other neurologic symptoms at the same time. MRI shows nothing changed from previous with stent in close contact with right optic tract (not optic nerve).  I asked the surgeon about this, and he said:

"The stent is not a normal stent, rather a flow diverter (changes the flow across the segment) so in her case it's in the communicating segment and it covers the ophthalmic artery. It's very commonly used. There are case reports on retinal ischemia following flow diversion, but not common. Once the stent is in and endothelialized ( which happens 4-6 weeks after placement), we can't take it out. "

Anyone have any experience with this situation?  Ideas on treatment? Her exam while asymptomatic is totally normal as is her VF and OCT.

Thanks in advance for any help you can provide

ELB

Eric L. Berman, MD

Dr. William A. and Sandra F. Johnson Endowed Chair in Neuro-Ophthalmology

Director, Neuro-Ophthalmology Service

Storm Eye Institute

Medical University of South Carolina

Good afternoon all,

I have a patient with history of right-sided posterior communicating aneurysm who initially underwent coil embolization and subsequently had pipeline embolization (flow diverter) 1 month later (11/14/24). She had angiogram 5/22/25 which showed no evidence of filling of the previously embolized right posterior communicating artery aneurysm and no evidence of stent complication. She was switched at that time from Brilinta to ASA 81 mg. She is on Eliquis for lower extremity DVT that developed after a 13 hour car ride following her hospital admission.

On 5/31/25 she developed acute loss of vision in the right eye and has now had 8 episodes.   7 of the 8 occurred related to daylight (7 when going from indoors out into the sun and 1 while driving into the sun) and 1 when she woke up in the morning.  All have been essentially the same lasting about 15 minutes before abating.  Sudden onset and cessation with no other neurologic symptoms at the same time. MRI shows nothing changed from previous with stent in close contact with right optic tract (not optic nerve).  I asked the surgeon about this, and he said:

"The stent is not a normal stent, rather a flow diverter (changes the flow across the segment) so in her case it's in the communicating segment and it covers the ophthalmic artery. It's very commonly used. There are case reports on retinal ischemia following flow diversion, but not common. Once the stent is in and endothelialized ( which happens 4-6 weeks after placement), we can't take it out. "

Anyone have any experience with this situation?  Ideas on treatment? Her exam while asymptomatic is totally normal as is her VF and OCT.

Thanks in advance for any help you can provide

ELB

Eric L. Berman, MD

Dr. William A. and Sandra F. Johnson Endowed Chair in Neuro-Ophthalmology

Director, Neuro-Ophthalmology Service

Storm Eye Institute

Medical University of South Carolina