ABSTRACT NUMBER: ESOC2026A1691 CLINICAL AND ANGIOGRAPHIC OUTCOMES OF ENDOVASCULAR TREATMENT FOR ISOLATED MCA DISSECTING ANEURYSMS

Abstract Background and aims Intracranial pseudoaneurysms comprise only 1% of all intracranial aneurysms and are associated with a mortality rate of up to 20%. This study aims to delineate the clinical, radiological, and treatment characteristics of isolated MCA dissecting aneurysms, emphasizing outcome differences between reconstructive and deconstructive strategies Methods This was a retrospective cohort study using a prospectively maintained database conducted at the Medical University of South Carolina. All angiographically confirmed unruptured dissecting aneurysms involving distal MCA (M2–M4) treated with either reconstructive or deconstructive endovascular approaches were included. Results Twelve patients with distal MCA dissecting aneurysms (five saccular, seven fusiform) were included. Nine (75%) underwent reconstructive therapy and three (25%) deconstructive therapy. M2 aneurysms were treated with reconstructive techniques (6/9), M3/M4 aneurysms with deconstructive techniques (2/3). Occlusion rates tended to be higher with deconstructive therapy (p = 0.06). Functional outcomes were similar between groups, with most patients achieving a mRS ≤ 1 at discharge (p = 0.83). Conclusions Our findings suggest that careful anatomical assessment, patient selection, and operator expertise are essential in guiding optimal management strategy. Both deconstructive and reconstructive strategies can be safe and effective when applied appropriately. Future multicenter cohort studies are needed to further refine patient-tailored management strategies. Conflict of interest Dr Spiotta: Research support from Penumbra, Stryker, Medtronic, and RapidAI. Consultant for Penumbra, Stryker, Terumo, and RapidAI. Dr Kan: Grants from the NIH (1U18EB029353-01) and unrestricted educational grants from Medtronic and Siemens. Consultant for Imperative Care and Stryker Neurovascular. Stock ownership in Vena Medical.