Mechanical Thrombectomy During Coiling of Acutely Ruptured Cerebral Aneurysms

Abstract

Thromboembolic events are common complications encountered during the endovascular treatment of acutely ruptured cerebral aneurysms. Major arterial occlusion may lead to serious neurological consequences, including significant morbidity or even death. While intra-arterial injection of thrombolytic or fibrinolytic agents can be effective for distal thrombus lysis, major arterial occlusion is sometimes resistant to such treatments. This study is a retrospective case series based on our database covering the period from January 2014 to December 2023. Five patients with complete large arterial occlusions occurring during the endovascular treatment of acutely ruptured aneurysms were treated with stent retrievers or direct aspiration. Patients’ demographics, angiographic findings, and clinical outcomes are discussed. A review of the relevant literature in English was also conducted. All occluded arteries were fully recanalized, with no infarctions detected on 24-h follow-up computed tomography scans. One patient, with a grade V on the Hunt and Hess (H&H) scale, died as a result of the disease course. The remaining patients recovered to their pre-intervention neurological baseline. Mechanical thrombectomy during the treatment of acutely ruptured aneurysms allows for rapid recanalization of occluded arteries without the need for intra-arterial thrombolytic or fibrinolytic therapy, yielding favorable clinical outcomes. To the best of our knowledge, this is the first literature review focused on thrombectomy in the context of acutely ruptured aneurysms.