Treatment of a giant terminal internal carotid artery aneurysm in a 10-year-old child by flow diversion: long-term outcome and lessons learned

TL;DR

A 10-year-old child with a large brain aneurysm underwent a complex stent procedure, which successfully prevented growth but caused some side effects.

Contribution

This case highlights the challenges and outcomes of using flow diversion for a rare, giant aneurysm in a pediatric patient.

Findings

The aneurysm remained fully occluded for 7 years after the procedure.

The patient experienced a mild transient dysphasia and permanent left eye vision loss.

Antiplatelet medications were safely discontinued one year post-procedure.

Abstract

A 28-mm diameter and partially thrombosed intracranial aneurysm was found in a 10-year-old boy on an MRI for non-specific headaches. The large neck incorporated the left internal carotid artery (ICA) termination and proximal middle cerebral artery. Treatment was planned to prevent further growth and rupture. Because of the difficult anatomy, a braided stent was first placed across the aneurysm neck as a scaffold to allow for the placement of a flow-diverting stent after its endothelialisation. However, severe stent-induced endothelial hyperplasia was encountered when the flow diverter was inserted. This resulted in a transient ICA occlusion during the procedure before flow was restored by angioplasty. As a result, the patient suffered a mild transient dysphasia but permanent loss of vision in the left eye. All antiplatelet medications were stopped 1 year after the procedure without problem. The aneurysm has remained fully occluded in the 7 years since.

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