Abstract 1122‐000017: Giant Brain Aneurysm: A Case Report in a Pediatric Patient

Introduction: The incidence of intracranial aneurysms in the pediatric population ranges from 1 to 3 per million inhabitants. Within this population, aneurysms are even rarer in lactating patients. Unlike the adult population, the male gender is predominant, and the incidence is more significant in the posterior circulation, with a higher percentage in the middle cerebral artery. Microsurgical and endovascular treatment has been described as feasible treatment in these cases. Methods: Methodology: Description of a case report of a patient admitted to the Pediatric Intensive Care service of the Hospital Materno Infantil in Tegucigalpa, Honduras. We took informed consent from parents for the patient’s treatment and subsequent academic dissemination of the clinical and neuroimaging data. Results: Case report: A two‐year‐old male patient presented to the pediatric emergency department with a 24‐hour evolution of sudden headache of severe intensity, accompanied by nausea and multiple episodes of vomiting. At hospital arrival, the patient presented an episode of generalized epileptic seizures. At the initial clinical neurological evaluation with altered consciousness somnolent. Motor examination revealed a right facial and body hemiparesis and Hunt and Hess of 1. Noncontrast cerebral tomography (NCCT) showed Fisher IV subarachnoid haemorrhage, left frontal lobar intraparenchymal hematoma and acute hydrocephalus (Fig 1A). Consequently, we placed an external ventricular shunt, for which the patient was admitted to the pediatric intensive care unit. The computed tomography angiography (CTA) showed a giant aneurysm in the anterior communicating artery (Fig. 1B). The patient underwent an endovascular procedure with the placement of coils with a successful result (Fig. 1C and Fig. 1D). Conclusions: Giant aneurysms are sporadic in children. They are commonly associated with the posterior circulation and, to a lesser extent, the middle cerebral artery is more commonly affected with the anterior circulation. Aneurysms in children tend to be more extensive compared to their adult counterparts. Clinically, they present with subarachnoid haemorrhage and seizures, as in our case. This case is a pediatric patient with a giant brain aneurysm at a less common age and rare localization. Endovascular management was successful, adding information to the therapeutic spectrum in these cases. It is essential to perform a detailed angiographic investigation. Surgery is the treatment of choice; however, clinical trials are needed to clarify endovascular versus microsurgical management

Abstract 1122‐000030: Satellite Model for the Management of Aneurysms to Desaturate the Third Level Health System

Introduction: The Centro Medico Nacional 20 de Noviembre is the most complex centre of the Mexican public health system. The SARS COV‐2 pandemic has progressively saturated health services at all levels, impacting chronic non‐communicable diseases 1. Aneurysmal subarachnoid haemorrhage has a mortality rate of up to 35% if not treated 2. Endovascular management of aneurysms provides a therapeutic possibility that shortens the time and reduces complications if implemented in an outpatient system with high standards of patient choice and reduces the chances of complications 3. We present a case series of patients with ruptured and unruptured brain aneurysms treated in a satellite system to reduce in‐hospital days and complications. Methods: A retrospective analysis was carried out of 66 patients admitted on an outpatient basis at the Centro Medico Nacional “20 de noviembre” between May 2020 to June 2021. The patients were entered into a “satellite” system for coils’ endovascular management or flow diverter, previously diagnosed with digital subtracter angiography and computed tomography angiogram. The analysis of variables was done using the Shapiro‐Wilk test to determine the normality of the sample distribution. The correlation of variables was done using Chi‐square. Results: The mean age of the patients was 53.8 years SD 14.31 years. 71.2% of the patients were female, and 28.2% were male. There was a 59.1% left predominance regarding the aneurysm side, 37.9% on the right side, and 3.0% was a single vessel. The arterial predominance was 77.3% anterior circulation. 95.5% of the patients underwent embolization with the placement of coils, and 4.5% had a flow diverter. The mean time of admission was 23.3 hours SD 12.4 hours. Complications occurred in 13.6% of the population studied, the most frequent being vasospasm, arterial occlusion, hydrocephalus, and death from aspiration pneumonia. The modified Rankin scale at 90 days was 0.38 SD 1.13. There was a significant relationship (p = 0.05) between the left side and complications. Conclusions: The management of aneurysms with a short in‐hospital time is a feasible solution in reducing the decongestion of tertiary health systems. Endovascular management with coils results in a low rate of complications, which is why this therapeutic route can be followed to desaturate third‐level health systems and a flow diversion in high well‐selected patients. The relationship between complication rates related to the left side of aneurysms is likely due to the more significant number of aneurysms on this side, not due to anatomical vessel idiosyncrasy

Abstract Number ‐ 18: Potential impact in low and middle‐income countries stroke networks of a deep learning triage tool

Introduction Early and accurate identification of large vessel occlusion (LVO) and intracranial hemorrhage (ICH) on initial neuroimaging is essential in a stroke network. A machine learning algorithm (MLA) able to predict LVO or ICH on non‐contrast computed tomography (NCCT) may accelerate workflows.We performed a validation analysis to measure the MLA accuracy among suspected stroke patients transferred to a Comprehensive Stroke Centre (CSC) in Mexico and the possible impact on the workflow in low and middle income countries (LMIC) . Methods From February 2021 to March 2022 consecutive patients with suspected acute stroke who underwent NCCT and computed tomography angiography (CTA) were included. MLA prediction of LVO and ICH was tested against expert physicians readings and clinical follow‐up. We calculated sensitivity, specificity, positive predictive value and negative predictive value. Receiver operating curves were generated for MLA‐LVO, MLA‐ICH and; areas under the curve were calculated. Potential time savings and impact on workflow times were calculated for a scenario in which MLA could analyse initial NCCT at PSC avoiding imaging repetition at CSC. Results 140 consecutive patients admitted from march 2021 to February 2022 were included in the study, final physicians diagnostics were: 22 ICH (15.7%) and 53 LVO (37.8%) MLA detected 22 ICH (15.7%) and 58 LVO (41.4%).The area under the curve for the identification of ICH with MLA was 0.97 (sensitivity: 94%, specificity: 91%, positive predictive value: 83.3%[MR1][JL2], negative predictive value: 100%). The area under the curve for the identification of LVO with MLA was 0.91 (sensitivity: 100%, specificity: 95.8%, positive predictive value: 85.7%, negative predictive value: 96.4%). Implementation of MLA‐LVO in the network could save CTA acquisition times of 40 (IQR 26) minutes by taking patients directly to the angiosuite for endovascular treatment. Conclusions In patients with suspected acute stroke, a MLA can quickly and reliably predict ICH and LVO. Such a tool could accelerate the diagnosis, mitigate the contrast imaging dependency and improve the workflow efficiency in stroke networks in LMIC where access to contrast imaging is often limited