Introduction Endovascular treatment of incidental intracranial aneurysms poses unique challenges, particularly regarding the management of thrombotic complications and their subsequent neurological sequelae. We present a case of a 64-year-old female with an incidental middle cerebral artery bifurcation aneurysm who developed hypodensity in the left caudate nucleus due to stent wall thrombus formation during endovascular treatment

Case Description Dual antiplatelet therapy with Aspirin and Brilique was initiated prior to endovascular treatment. A flow-diverter stent was deployed during the procedure, with the distal part positioned in the lower M2 branch and the proximal part in bifurcation of ACI. Thrombotic masses led to closure of medial branches of the left A1 segment, necessitating Tirofiban application via microcatheter for recanalization. Postoperatively, the patient was without neurological deficits. Brain CT revealed hypodensity in the left caudate nucleus due to perforator occlusion secondary to stent thrombosis.The observed hypodensity in the left caudate nucleus highlights the potential ischemic complications associated with endovascular treatment of intracranial aneurysms, particularly related to perforator occlusion secondary to stent thrombosis. Perforator occlusion can lead to neurological deficits and highlights the importance of careful procedural planning and postoperative monitoring to mitigate these complications. Additionally, the development of hypodensity underscores the need for prompt recognition and management of thrombotic complications to prevent irreversible ischemic damage.

Results This case emphasizes the significance of recognizing and managing thrombotic complications, particularly perforator occlusion, following endovascular treatment of intracranial aneurysms. Close postoperative monitoring and timely intervention are crucial for optimizing outcomes and minimizing neurological sequelae in these patients.

Disclosure of Interest no.