J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://jnr.elmerpub.com

Case Report

Volume 15, Number 2, March 2025, pages 93-103

Mechanical Thrombectomy During Coiling of Acutely Ruptured Cerebral Aneurysms

Figure 1. Case 1. (a) Anteroposterior (AP) angiography showing a basilar tip aneurysm (red arrow). (b) AP view with caudal angulation view showing occluded left posterior cerebral artery (PCA) (green arrow). (c) Oblique view angiography showing occlusion of the right PCA (yellow arrow) with patent left PCA. (d) Post mechanical thrombectomy final angiography showing both patent PCAs.

Figure 2. Case 2. (a) Anteroposterior angiographic view showing a posterior communicating aneurysm (yellow arrow). (b) Anteroposterior angiographic view showing occluded M1 segment (green arrow). (c) Native view showing the deployed stent retriever (red arrow). (d) Oblique angiographic view showing the coiled aneurysm with patency of the middle cerebral artery (white arrow).

Figure 3. Case 3. (a) Anteroposterior angiography showing an anterior communicating aneurysm (red arrow). (b) Anteroposterior angiography showing the coiled aneurysm (blue arrow) with a remodeling balloon (red arrow). (c) Post coiling anteroposterior angiography showing occluded A1 segment (blue arrow). (d) Anteroposterior native angiography showing patent anterior cerebral artery through the deployed stent retriever struts (green arrow). (e) Final anteroposterior angiography showing patent anterior cerebral artery (blue arrow).

Figure 4. Case 4. (a) Anteroposterior angiography showing internal carotid terminus aneurysm (red arrow). (b) Post coiling of the aneurysm anteroposterior angiography showing M1 occlusion (blue arrow). (c) Lateral view angiography showing occluded middle cerebral artery (green arrow). (d) Post mechanical thrombectomy anteroposterior angiography showing recanalized middle cerebral artery (yellow arrow). (e) Post mechanical thrombectomy lateral view angiography showing recanalized middle cerebral artery (blue arrow).

Figure 5. Case 5. (a) Anteroposterior angiography showing middle cerebral artery aneurysm (red arrow). (b) Post coiling anteroposterior angiography with balloon remodeling (white arrow). (c) Anteroposterior angiography showing occluded distal internal carotid artery (green arrow). (d) Post mechanical thrombectomy anteroposterior angiography showing recanalized middle cerebral artery.

**Table 1.** Patients Demographics and Clinical Outcome
Case	Age	Sex	Size in mm	Location	H&H	Site	Relation to the aneurysm	Balloon	Stent	Simple coiling	DM	Device	RT in min	GP IIB/IIIA inhibitor/fibrinolytic drugs	TICI	INF	HC	mRS	ACT
ACOM: anterior communicating; DM: double microcatheter; GP: glycoprotein; HC: hemorrhagic complication; H&H: Hunt and Hess grading; ICA: internal carotid artery; INF: infarction; MCA: middle cerebral artery; MRS: modified Rankin scale; PCA: posterior cerebral artery; PCOM: posterior communicating; RT: recanalization time; TICI: thrombolysis in cerebral infarction.
Case 1	58	M	6.1 × 7.8	Basilar tip	V	Both PCA	Distal	Yes	No	No	No	RED 62	38	No	TICI 3	No	No	6	162
Case 2	50	F	7 × 6	Right PCOM	I	M1	Distal	Yes	No	No	No	Solitaire AB 4 × 20 mm	18	No	TICI 3	No	No	0	Not measured
Case 3	45	M	2.5 × 3	ACOM	II	A1	Proximal	Yes	No	No	No	Solitaire AB 4 × 20 mm	20	No	TICI 3	No	No	0	116
Case 4	36	F	4.6 × 7	ICA terminus	I	M1	Distal	Yes	No	No	No	Solitaire AB 4 × 20 mm	28	No	TICI 3	No	No	0	154
Case 5	68	F	6.8 × 8	Right MCA	III	Distal ICA	Proximal	Yes	No	No	No	Solitaire AB 4 × 20 mm	25	No	TICI 3	No	No	3	Not measured

Table 1. Patients Demographics and Clinical Outcome

Case

Age

Sex

Size in mm

Location

H&H

Site

Relation to the aneurysm

Balloon

Stent

Simple coiling

Device

RT in min

GP IIB/IIIA inhibitor/fibrinolytic drugs

TICI

INF

mRS

ACT

ACOM: anterior communicating; DM: double microcatheter; GP: glycoprotein; HC: hemorrhagic complication; H&H: Hunt and Hess grading; ICA: internal carotid artery; INF: infarction; MCA: middle cerebral artery; MRS: modified Rankin scale; PCA: posterior cerebral artery; PCOM: posterior communicating; RT: recanalization time; TICI: thrombolysis in cerebral infarction.

Case 1

6.1 × 7.8

Basilar tip

Both PCA

Distal

Yes

RED 62

TICI 3

162

Case 2

7 × 6

Right PCOM

Distal

Yes

Solitaire AB 4 × 20 mm

TICI 3

Not measured

Case 3

2.5 × 3

ACOM

Proximal

Yes

Solitaire AB 4 × 20 mm

TICI 3

116

Case 4

4.6 × 7

ICA terminus

Distal

Yes

Solitaire AB 4 × 20 mm

TICI 3

154

Case 5

6.8 × 8

Right MCA

III

Distal ICA

Proximal

Yes

Solitaire AB 4 × 20 mm

TICI 3

Not measured

**Table 2.** Patients Demographics and Clinical Outcome of the Reviewed Cases in the Literature
Author	Number of patients	Age	Sex	Size in mm	Aneurysm location	Site of the occlusion	Thrombus relation to the aneurysm	Balloon	Stent	Simple coiling	Double microcatheter	Device	Time to recanalization in min	IA(GP) IIB/IIIA inhibitor/fibrinolytic drugs	TICI	Infarction	Hemorrhagic complication	Outcome	ACT in s
ACOM: anterior communicating; ACT: activated clotting time; ANT CHOR: anterior choroidal; GP: glycoprotein; ICA: internal carotid artery; MCA: middle cerebral artery; MRS: modified Rankin scale; NA: not available; PCOM: posterior communicating; rTPA: recombinant tissue plasminogen activator; TICI: thrombolysis in cerebral infarction.
Hirata et al, 2020 [7]	1	58	Male	2.3 × 1.9	RT MCA	M1 segment	Proximal	No	No	1	No	Solitaire 4 × 20 + 5Max aspiration catheter	59	No	TICI 3	Yes	No	mRS 0 in 90 days	134
Ahn et al, 2017 [8]	15	Mean 54.7 ± 11.8	9 females, 6 males	Diameter range 3.3 - 10.1 mm	PCOM 6, ACOM 4, MCA 2, ANT CHOR 1, vertebral 1, Paraclinoid 1	MCA 11, distal ICA 2, proximal ICA 1, vertebral 1	Interface 2, proximal 3 and distal 10	No	2	10	3	Solitaire FR	Mean 36.3 ± 22.6	Tirofiban in five patients	TICI 3 in 13, TICI 2B in 2	3	2 from Tirofiban	mRS 1 in 9, mRS2 in 3, mRS3 in 1, mRS 4 in 1 and mRS 6 in 1	NA
Zhang et al, 2012 [9]	2	52, 54	Males	6.5, 3	ACOM	M2, M1	Distal	No	No	Yes	No	Solitaire 4 × 20	NA	No	TICI 3	Yes	No	One died mRS 6 and one had mixed aphasia mRS3	Not measured
Briganti et al, 2016 [10]	1	58	Female	6	ACOM	Superior trunk MCA	Distal	No	No	Yes	No	Solitaire 3 × 20	NA	No	TICI 3	No	No	mRS 0	NA
Drakopoulou et al, 2022 [11]	1	55	Male	6	ACOM	A2	Distal	No	No	Yes	No	Aspiration Exclesior SL 10	67	Tirofiban	TICI 2A	Yes	No	mRS 0	NA
Kang et al, 2012 [12]	2	62, 45	Males	NA	ICA terminus and left MCA bifurcation	ICA termination and distal M2 of the inferior trunk MCA	Coil interface, distal	No	No	Yes	Yes	Penumbra aspiration catheter 041 and 032	NA	Tirofiban	TICI3 and 2B	No	No	No deficits mRS 0	Twice the control
Domingo et al, 2021 [13]	1	42	Male	NA	Left ICA	ICA	Coil interface	No	No	Yes	No	Aspiration catheter (not specified)	NA	GP IIB/IIIA inhibitor	TICI 3	No	No	No additional deficit	NA
Aketa et al, 2016 [14]	1	53	Male	7 × 5 × 5	Basilar tip	Basilar trunk	Proximal	Yes	No	No	No	Solitaire FR 4 × 15	330	No	TICI 3	No	No	Slight neuropsychologic dysfunction mRS 1	200 - 250
Xu et al, 2019 [15]	1	45	Male	5.2 × 3.7	Supraclinoid ICA	From the ophthalmic origin to M1	Proximal to distal	NO	Yes	No	No	Solitaire 6 × 20	NA	Urokinase	TICI3	No	No	mRS 0	NA
Demartini et al, 2018 [16]	4	61, 47, 57, 54	3 females	3, 3, 7, 13	Basilar tip, 2 ACOM, PCOM	P1 and P3, M1, M2, M1	Distal	3	1	1	0	Solitaire 4 × 15 and 4 × 20	38, 37, 77, 45	rTPA in 1	2 TICI3, 1 TICI 2b and 1 TICI2a	NA	No	Homonymous hemianopia mRS 2, cognitive impairment and L hemiparesis mRS3, aphasia and facial palsy mRS1, complete recovery mRS0	NA

Table 2. Patients Demographics and Clinical Outcome of the Reviewed Cases in the Literature

Author

Number of patients

Age

Sex

Size in mm

Aneurysm location

Site of the occlusion

Thrombus relation to the aneurysm

Balloon

Stent

Simple coiling

Double microcatheter

Device

Time to recanalization in min

IA(GP) IIB/IIIA inhibitor/fibrinolytic drugs

TICI

Infarction

Hemorrhagic complication

Outcome

ACT in s

ACOM: anterior communicating; ACT: activated clotting time; ANT CHOR: anterior choroidal; GP: glycoprotein; ICA: internal carotid artery; MCA: middle cerebral artery; MRS: modified Rankin scale; NA: not available; PCOM: posterior communicating; rTPA: recombinant tissue plasminogen activator; TICI: thrombolysis in cerebral infarction.

Hirata et al, 2020 [7]

Male

2.3 × 1.9

RT MCA

M1 segment

Proximal

Solitaire 4 × 20 + 5Max aspiration catheter

TICI 3

Yes

mRS 0 in 90 days

134

Ahn et al, 2017 [8]

Mean 54.7 ± 11.8

9 females, 6 males

Diameter range 3.3 - 10.1 mm

PCOM 6, ACOM 4, MCA 2, ANT CHOR 1, vertebral 1, Paraclinoid 1

MCA 11, distal ICA 2, proximal ICA 1, vertebral 1

Interface 2, proximal 3 and distal 10

Solitaire FR

Mean 36.3 ± 22.6

Tirofiban in five patients

TICI 3 in 13, TICI 2B in 2

2 from Tirofiban

mRS 1 in 9, mRS2 in 3, mRS3 in 1, mRS 4 in 1 and mRS 6 in 1

Zhang et al, 2012 [9]

52, 54

Males

6.5, 3

ACOM

M2, M1

Distal

Yes

Solitaire 4 × 20

TICI 3

Yes

One died mRS 6 and one had mixed aphasia mRS3

Not measured

Briganti et al, 2016 [10]

Female

ACOM

Superior trunk MCA

Distal

Yes

Solitaire 3 × 20

TICI 3

mRS 0

Drakopoulou et al, 2022 [11]

Male

ACOM

Distal

Yes

Aspiration Exclesior SL 10

Tirofiban

TICI 2A

Yes

mRS 0

Kang et al, 2012 [12]

62, 45

Males

ICA terminus and left MCA bifurcation

ICA termination and distal M2 of the inferior trunk MCA

Coil interface, distal

Yes

Penumbra aspiration catheter 041 and 032

Tirofiban

TICI3 and 2B

No deficits mRS 0

Twice the control

Domingo et al, 2021 [13]

Male

Left ICA

ICA

Coil interface

Yes

Aspiration catheter (not specified)

GP IIB/IIIA inhibitor

TICI 3

No additional deficit

Aketa et al, 2016 [14]

Male

7 × 5 × 5

Basilar tip

Basilar trunk

Proximal

Yes

Solitaire FR 4 × 15

330

TICI 3

Slight neuropsychologic dysfunction mRS 1

200 - 250

Xu et al, 2019 [15]

Male

5.2 × 3.7

Supraclinoid ICA

From the ophthalmic origin to M1

Proximal to distal

Yes

Solitaire 6 × 20

Urokinase

TICI3

mRS 0

Demartini et al, 2018 [16]

61, 47, 57, 54

3 females

3, 3, 7, 13

Basilar tip, 2 ACOM, PCOM

P1 and P3, M1, M2, M1

Distal

Solitaire 4 × 15 and 4 × 20

38, 37, 77, 45

rTPA in 1

2 TICI3, 1 TICI 2b and 1 TICI2a

Homonymous hemianopia mRS 2, cognitive impairment and L hemiparesis mRS3, aphasia and facial palsy mRS1, complete recovery mRS0