P.195 Giant aneurysm, tiny patient: flow diversion stenting of a giant MCA aneurysm in a young child

Abstract

Background: A 3-year-old girl presented with a 6-day history of severe headaches. On examination, upper motor neuron signs were noted in the left upper and lower extremities with increased tone, reflexes, and a positive Babinski sign. MRI of the brain revealed a giant right middle cerebral artery (MCA) aneurysm with significant mass effect, associated with cerebral edema and ventricular effacement. CT and CT angiogram showed evidence of aneurysmal wall calcification and lamellar thrombosis within the aneurysmal sac. In addition, there was a smaller right MCA aneurysm in close proximity to the giant aneurysm. Methods: After a balloon occlusion test to assess collateral blood flow to the MCA territory, it was decided to treat both aneurysms with a flow diverting stent. Dual antiplatelet loading was done with aspirin and clopidogrel. The smallest available diameter of Pipeline Shield stent was deployed. Results: The patient remained neurologically unchanged. Early follow-up imaging demonstrated stent patency, reduced size and mass effect of the large aneurysm, reduced cerebral edema, and no flow into the smaller aneurysm. Conclusions: Flow diversion stenting may be employed successfully in pediatric patients, though has unique technical considerations including small size vessels and limited evidence for antiplatelet agent choice and dosing.