Stent retriever thrombectomy with aneurysm in target vessel: Technical note

Area of Science:

• Neurology
• Vascular Neurology
• Interventional Neuroradiology

Background:

• Aneurysms in large occluded cerebral vessels pose significant risks during acute stroke interventions.
• Catastrophic rupture is a major concern for neuro-interventionists.
• Treatment decisions must balance reperfusion needs with aneurysm risks.

Observation:

• A case of left internal carotid artery-middle cerebral artery (MCA) ischemic stroke with a pre-existing MCA bifurcation aneurysm was managed.
• Intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MTE) using a stent retriever were performed proximal to the aneurysm.
• Successful TICI 2b recanalization was achieved.

Findings:

• Mechanical thrombectomy and IV tPA can be safely performed in patients with acute ischemic stroke and known target vessel aneurysms.
• The presence of an incidental aneurysm did not preclude successful reperfusion therapy.
• The intervention was technically successful with good recanalization.

Implications:

• These findings suggest that acute stroke interventions should not be withheld solely based on the presence of a known target vessel aneurysm.
• Careful procedural planning and execution are crucial for managing such complex cases.
• Further studies may be warranted to establish definitive guidelines for managing stroke in the presence of aneurysms.