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

Figures

↓  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 1.
↓  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 2.
↓  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 3.
↓  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 4.
↓  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.
Figure 5.

Tables

↓  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 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