Abstract 413: Flow Diverters in Pediatric Intracranial Aneurysms: Single‐Centre Experience and Review of Literature

Introduction Pediatric intracranial aneurysms (PIAs) are uncommon and often present with complex morphologies. Traditionally, these are treated by endovascular or surgical deconstruction, however these options are sometimes limited by anatomical or hemodynamic constraints. Flow diverters offer a reconstructive approach by redirecting blood flow in the parent artery and promoting aneurysm thrombosis. Despite excellent outcomes in adults, the literature on outcomes in pediatric applications is sparse. We aim to evaluate the effectiveness and safety of flow diverters in pediatric intracranial aneurysms. Methodology: A retrospective analysis was conducted of consecutive children who underwent endovascular treatment for intracranial aneurysms using flow diversion between January 2018 and December 2024. Demographic, developmental, clinical, treatment, and imaging characteristics were collected at presentation and follow‐up. Treatment success was defined as complete obliteration of PIA on angiography using O’Kelly‐Marotta classification during follow‐up. Safety was defined as ischemic events, hemorrhagic events, and all‐cause mortality. Results Four girls and one boy were identified as treated with flow diversion. Their mean age at treatment was 11.2 years (range: 6‐15 years). Aneurysmal subarachnoid hemorrhage was seen in two children, one child presented with transient ischemic attacks, one with third cranial nerve palsy and one with asymptomatic growing aneurysm. The PIAs included giant saccular aneurysm (n=1), saccular (n=1), blister aneurysm (n=1), dissecting/dysplastic fusiform aneurysm (n=1) and iatrogenic pseudoaneurysm (n=1). Four (80%) patients failed the balloon occlusion test. No intra‐procedural complications were seen. All patients received post‐procedural weight‐based dual antiplatelet therapy for a period of 6 months followed by aspirin monotherapy. Symptomatic ischemic complications were seen in three patients (60%), one at 48 hours, one at 3 months and the third associated with delayed occlusion of flow diverter constructs at one‐year follow‐up. Over a mean follow‐up duration of 25.6 months, complete occlusion of PIAs and vascular remodeling were seen in all patients. Contemporary literature, with five studies reporting the use of the Pipeline embolization device (PED), FRED, Silk, and Surpass, reports PIA occlusion rates ranging from 73.4% to 100%. Complications were reported in up to 6.6% of these children. Conclusion Although flow diverters offer a promising reconstructive treatment option for endovascular treatment of PIAs, current experience indicates a potential risk of immediate and mid‐term ischemic complications. At present, deconstructive approaches remain the most established treatment for PIAs, while reconstructive strategies may be considered in carefully selected situations. image

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