Abstract 268: Endovascular Treatment for Non‐Resectable Meningiomas Encasing the Internal Carotid Artery: A Case Report

Introduction Carotid endovascular treatment with stenting is widely recognized as a safe and effective method for managing carotid stenosis due to underlying atherosclerotic disease. However, there is limited data on the efficacy of carotid stenting in cases where non‐resectable meningiomas encase the internal carotid artery. Presentation We report the case of a 50‐year‐old woman who initially presented with numbness in her right arm. Brain MRI revealed bilateral meningiomas encasing the cavernous segments of both internal carotid arteries, leading to mild narrowing. Follow‐up imaging showed that the left‐sided meningioma had enlarged, causing near occlusion of the left internal carotid artery and resulting in recurrent acute infarcts within the left ICA watershed territory. This led to the decision to proceed with a left STA‐MCA bypass. The patient later experienced right‐sided amaurosis fugax, with subsequent MRI showing further enlargement of the right‐sided meningioma encasing the right cavernous ICA. The patient underwent angioplasty and stenting of the right ICA, with no further neurological symptoms. Discussion Meningiomas are the most common tumors affecting the cavernous sinus and can invade the walls of the internal carotid artery, leading to significant stenosis. However, neurological deficits and cerebral ischemia due to reduced cerebral perfusion pressure from such stenosis are uncommon. Tumor resection in these scenarios poses risks, including carotid scarring and third nerve injury, emphasizing the need for alternative treatments. This case illustrates the safety and effectiveness of carotid artery stenting in such complex situations. Conclusion Carotid artery stenting is a viable and effective treatment option for patients with non‐resectable meningiomas causing symptomatic narrowing of the internal carotid artery.