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Ruptured hidden intracranial aneurysm during mechanical thrombectomy: A case report
Toshiki Nozaki1,2, Masayuki Noda2, Toshihiro Ishibashi3
1Department of Neurological Surgery, Nippon Medical School Hospital, Bunkyo-ku, Tokyo.
Surgical Neurology International
|January 7, 2021
Summary
A rare case of subarachnoid hemorrhage during mechanical thrombectomy for acute ischemic stroke is presented. Surgeons should prepare for potential hidden aneurysm rupture during stent retriever procedures.
Area of Science:
- Neurology
- Interventional Neuroradiology
Background:
- Acute ischemic stroke (AIS) patients exhibit a higher prevalence of cerebral aneurysms.
- Hidden aneurysms in AIS patients with large-vessel occlusion are considered rare.
- This case highlights a rare instance of subarachnoid hemorrhage (SAH) during mechanical thrombectomy (MT).
Observation:
- A 46-year-old patient with right internal carotid artery terminal occlusion underwent MT for AIS symptoms.
- Initial thrombectomy with a stent retriever was unsuccessful.
- Angiography revealed SAH before the second thrombectomy attempt.
Findings:
- Successful recanalization (thrombolysis in cerebral infarction 2b) and hemostasis were achieved by lowering blood pressure.
- A ruptured aneurysm was subsequently treated with coil embolization.
- Aneurysm rupture during MT with stent retrievers is infrequently reported, possibly linked to stent withdrawal.
Implications:
- Pre-procedural detection of hidden aneurysms is challenging.
- Neurointerventionalists must anticipate potential hidden aneurysm rupture distal to the occlusion.
- Preparedness for prompt management of ruptured aneurysms post-MT is crucial.
