P051 Adult hemorrhagic stroke from untreated asymptomatic pial AVF originating in childhood

<h3>Introduction</h3> Pial arteriovenous fisutula is a rare disease that accounts for 1.6% of all cerebral arteriovenous malformation and is known to manifest symptoms of high-ejection fraction heart failure in infancy or childhood. However, if the patient passes an asymptomatic childhood, hemorrhagic stroke may occur in adulthood. In this case, we would like to report a case in which endovascular treatment was performed on a patient who was asymptomatic as a child, was not followed up, and then developed a hemorrhagic stroke as an adult. <h3>Case Description</h3> A 36-year-old male, presented to the emergency department with a sudden onset of decreased consciousness. Brain computed tomography revealed whole ventricle intraventricular hemorrhage and intracerebral hemorrhage in the left occipital lobe. Subsequent brain CT angiography identified an arteriovenous malformation. Transfemoral cerebral angiography was performed. Angiographic findings confirmed the confluence of anterior, middle and posterior cerebral artery in the left side, which subsequently formed a venous pouch, indicating a pial arteriovenous fistula (AVF). An endovascular treatment was decided for this case. <h3>Results</h3> Distal access was achieved to perform microcatheterization, positioning the catheter at the fistular point. Coil embolization was performed, achieving complete obliteration. During the procedure, there was an event of premature coil detachment, which migrated to the transverse sinus. Final angiography revealed the disappearance of antegrade flow in the anterior cerebral artery and a slowed retrograde flow from the middle cerebral artery to the anterior cerebral artery. But no newly acute infarction occurred within the ACA territory. <h3>Disclosure of Interest</h3> no.