ABSTRACT NUMBER: ESOC2026A2299 SYMTOMATIC DEVELOPMENTAL VENOUS ANOMALY (DVA) WITH VEIN OF GALEN STENOSIS TREATED BY VENOUS STENTING

Abstract Background and aims Developmental venous anomalies (DVAs) are common, usually benign congenital variants of cerebral venous drainage that may rarely become symptomatic due to venous outflow obstruction, and venous hypertension. Endovascular treatment of symptomatic DVAs is exceptionally rare; we report a case successfully treated with venous stenting. Methods A 65-year-old man presented with acute right-sided hemiparesis, severe aphasia, and NIHSS-score 20. CT angiography with perfusion showed no arterial occlusion but revealed increased cerebral blood volume and cerebral blood flow with mildly prolonged mean transit time in the left frontal region. MRI revealed a large frontal DVA with classic “caput medusae” morphology draining via medullary veins into the internal cerebral vein and a stenotic vein of Galen, with associated frontoparietal watershed infarcts and superficial left frontal enhancement consistent with chronic venous congestion and development of pial collaterals. The patient developed epileptic seizures with persistent deficits, and venous manometry showed a 4–5 mmHg gradient between the internal cerebral vein and straight sinus. Due to severe symptoms and a significant pressure gradient, venous stenting was performed using a 5×25 mm Acclino stent with balloon dilatation, reducing the gradient to 1–2 mmHg and resulting in rapid recovery (NIHSS 0 by day 7), with sustained stent patency and no new infarctions on follow-up. Conclusions This rare case of symptomatic DVA with vein of Galen stenosis demonstrates complete clinical and radiological remission after venous stenting, underscoring the importance of venous pathophysiology in atypical infarct patterns and the potential role of endovascular intervention in selected patients. Conflict of interest Mahtab Zamani: Nothing to disclose. Brian Enriquez: Nothing to disclose. Christian Lund: Nothing to disclose. Martin Sökjer-Petersen: Nothing to disclose. Ruth Sletteberg: Nothing to disclose.