P031 Management and endovascular treatment of an infectious false aneurysm of the petrous internal carotid artery in the setting of septic thrombosis of the cavernous sinus

<h3>Introduction</h3> Current guidelines lack specific recommendations for the acute endovascular treatment of unruptured infectious intracranial aneurysms presenting with cranial nerve palsy. <h3>Case Description</h3> A 59-year-old woman presented to the emergency department complaining of headaches. Brain-CT revealed bilateral cavernous sinus thrombosis with purulent contents, along with stenosis of the cavernous and petrous portions of the left internal carotid artery due to infectious arteritis. Sudden onset of diplopia 15 days later prompted further MRI, which identified an infectious aneurysm in the petrous portion of the left internal carotid artery. A multidisciplinary decision was made to embolize the aneurysm once the septic condition was controlled through sterile blood cultures and effective antibiotic therapy. Endovascular treatment involved dual antiplatelet therapy and therapeutic anticoagulation, deploying a flow-diverter opposite the aneurysm sac followed by coil obliteration using the jailing technique, achieving satisfactory exclusion post-procedure. However, suspicion of hemorrhagic shock arose post-procedure. Emergency CT scan revealed a large sub- and retroperitoneal hematoma with active bleeding from the puncture sites of both common femoral arteries. Urgent arteriography of femoral arterial approaches failed to reveal active bleeding, subsiding after prolonged manual compression and compression dressing. At the two-year mark, satisfactory exclusion of the aneurysm persisted with no residual neurological deficit. <h3>Results</h3> This case underscores the challenges in managing unruptured infectious intracranial aneurysms associated with cranial nerve palsy, particularly the placement of endovascular devices in a septic environment and managing associated complications. <h3>Disclosure of Interest</h3> no.