P.155 Giant aneurysm, tiny patient: flow diversion stenting of a giant MCA aneurysm in a young child

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