Scepter-Mini Balloon Assisted Coil Embolization of an Intracranial Arterial Aneurysm in a Child with PHACE Syndrome...

Area of Science:

• Pediatric Neurology
• Interventional Neuroradiology
• Vascular Malformations

Background:

• PHACE syndrome is a complex disorder associated with cerebrovascular abnormalities, including moyamoya arteriopathy and intracranial aneurysms.
• Cerebral vascular malformations are a significant feature in children diagnosed with PHACE syndrome.
• Aberrant intracranial arteries can complicate treatment of aneurysms in affected children.

Observation:

• A pediatric patient with PHACE syndrome presented with a growing left posterior-communicating artery aneurysm.
• The aneurysm originated from an aberrant left internal carotid artery (LICA) with a narrow proximal caliber.
• Standard endovascular approaches were challenging due to the LICA's anatomy.

Findings:

• Successful treatment of the LICA aneurysm was achieved using balloon-assisted coiling (BAC).
• A novel endovascular route was employed, navigating a microcatheter from the basilar artery into the LICA via a persistent trigeminal artery.
• A Scepter Mini balloon microcatheter facilitated aneurysm neck remodeling during the coiling procedure.

Implications:

• This case demonstrates a viable endovascular strategy for treating complex aneurysms in pediatric PHACE syndrome patients with challenging LICA anatomy.
• The successful use of a persistent trigeminal artery as an access route highlights its potential in complex neurovascular interventions.
• This approach may offer a less invasive alternative for managing specific cerebrovascular malformations in pediatric patients.