C88 Embolization of a multilobulated symptomatic pcom ica aneurysm with p64: inappropriate opening, migration of the stent and successful reposition

<h3>Introduction</h3> Posterior communicating artery (PCoM) aneurysms pose a unique therapeutic challenge due to their proximity to critical vascular branches and variable morphology. Flow diverters have emerged as a viable treatment option for multilobulated intracranial aneurysms. However, complications such as incomplete device expansion, migration of the device and occlusion of normal arteries can affect treatment efficacy and long-term outcomes. <h3>Case Description</h3> We report the case of a 70-year-old woman who presented with left side third cranial nerve palsy. Imaging revealed a 6.3 mm multilobulated saccular aneurysm at the left PCoM. Endovascular treatment with a p64 HPC was planned. During deployment, incomplete opening of the flow diverter was observed in the mid-portion of the stent with good apposition in the distal and proximal part. Balloon angioplasty was attempted but achieved only partial correction and a distal migration of whole device with occlusion of ICA bifurcation and of the anterior cerebral artery (ACA). We attempted reposition or removing completely the device using a balloon, 2 different stentretrievers and Comaneci device. With Comaneci we were able to move down the p64 in a safe position. Aneurysm neck was covered and all the arteries remained opened. The patient remained neurologically at preoperative level, with subsequent improvement in her third cranial nerve palsy. <h3>Conclusions</h3> This case highlights a technical complication of flow diverter deployment, malfunction in stent opening. Using balloon angioplasty and a variety of devices and techniques allows us to open properly the device and prevent future complications. <h3>Conflict of Interest</h3> No