PT  - JOURNAL ARTICLE
AU  - Grin, E
AU  - Kvint, S
AU  - Raz, E
AU  - Shapiro, M
AU  - Sharashidze, V
AU  - Rutledge, C
AU  - Riina, H
AU  - Nelson, P
AU  - Nossek, E
TI  - O-011 Endovascular flow diverter stents for acute iatrogenic cerebrovascular injuries
AID  - 10.1136/jnis-2024-SNIS.11
DP  - 2024 Jul 01
TA  - Journal of NeuroInterventional Surgery
PG  - A8--A9
VI  - 16
IP  - Suppl 1
4099  - http://jnis.bmj.com/content/16/Suppl_1/A8.short
4100  - http://jnis.bmj.com/content/16/Suppl_1/A8.full
SO  - J NeuroIntervent Surg2024 Jul 01; 16
AB  - Introduction and Objective Intraoperative iatrogenic cerebrovascular injury can cause intracranial hemorrhage and pseudoaneurysm formation, putting patients at high risk for postoperative bleeding or vessel rupture. As no established protocol for the treatment of these acute vessel injuries exists, we sought to describe our institution’s experience treating patients who suffered iatrogenic neurosurgical cerebrovascular injuries.Methods Patient electronic medical records were retrospectively reviewed. We reviewed the type of injury, timing of diagnosis, and endovascular management, including antiplatelet regimens, as well as embolization results and clinical outcome.Results A total of six patients were included in this study. Three patients suffered an injury to the internal carotid artery, one to the left anterior cerebral artery, one to the right posterior cerebral artery, and one to the basilar artery. Four of the six injuries occurred during attempted tumor resection, one during cerebrospinal fluid (CSF) leak repair, and one during attempted microsurgical clipping of an ophthalmic artery aneurysm. Three injuries occurred with transnasal endoscopic approach. All six vessel injuries resulted in pseudoaneurysm formation, one of which included vessel dissection, and five of the injuries were associated with vasospasm. Four of the pseudoaneurysms were immediately detected on postoperative angiography; two were initially negative on angiography and were not detected until postoperative days four and five. Five were treated with a Pipeline Embolization Device (PED) and one with a Silk Vista Baby. Two injuries were treated with two PEDs telescopically overlapped across the pseudoaneurysm. All devices deployed successfully. Patients were maintained postoperatively on a dual antiplatelet therapy of aspirin and clopidogrel or ticagrelor. No parent artery occlusion or stenosis was observed, and complete pseudoaneurysm occlusion was observed in four patients (except in two patients for whom follow-up imaging could not be obtained).Conclusions With proper antiplatelet regimens, flow diverter stents can be used safely to successfully treat these complex acute iatrogenic injuries. Early repeated angiogram is needed when immediate post-injury imaging does not discover the point of vessel injury.View this table:Abstract O-011 Table 1 Injury and diagnosisView this table:Abstract O-011 Table 2 TreatmentDisclosures E. Grin: None. S. Kvint: None. E. Raz: None. M. Shapiro: None. V. Sharashidze: None. C. Rutledge: None. H. Riina: 2; C; Siemens, Medtronic. P. Nelson: None. E. Nossek: None.