Cangrelor use in a pediatric patient with aneurysmal subarachnoid hemorrhage

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Subarachnoid hemorrhage (SAH) in pediatric patients can result from ruptured internal carotid artery (ICA) aneurysms.
• Complex aneurysm anatomy presents challenges for endovascular treatment.
• Optimal antiplatelet therapy is crucial for preventing thrombotic and hemorrhagic complications after stent placement.

Purpose of the Study:

• To report a successful endovascular treatment of a pediatric SAH case caused by a ruptured ICA saccular aneurysm.
• To highlight the use of a flow diverter stent in conjunction with coiling for challenging aneurysm morphology.
• To discuss the management of dual antiplatelet therapy in the acute setting.

Main Methods:

• Endovascular coiling combined with flow diverter stent placement for a ruptured ICA saccular aneurysm.
• Administration of intravenous cangrelor followed by oral aspirin and transition to clopidogrel.
• Acute management of subarachnoid hemorrhage in a pediatric patient.

Main Results:

• Successful deployment of the flow diverter stent and coils, achieving aneurysm occlusion.
• No ischemic or hemorrhagic complications occurred during or after the intervention.
• The patient was discharged symptom-free 24 days post-procedure.

Conclusions:

• Flow diverter stent placement is a viable option for treating complex pediatric intracranial aneurysms, even in acute settings.
• Careful peri-procedural antiplatelet management, including transition from cangrelor to thienopyridine, is critical for favorable outcomes.
• This case underscores the importance of tailored endovascular strategies and meticulous medical management for pediatric neurovascular emergencies.