Mechanical Thrombectomy for Acute Cerebral Large Vessel Occlusions Involving a Cerebral Aneurysm in the Target Vessel

Objective: Mechanical thrombectomy (MT) for acute cerebral large vessel occlusion (LVO), which involves a cerebral aneurysm in the target vessel, indicates a risk of rupture of the aneurysm. Safety of the MT for LVO involving cerebral aneurysm was examined. Methods: In all, 240 consecutive patients with LVO were treated with MT between January 2018 and December 2019. Angiographic images and clinical records of patients with LVO involving cerebral aneurysm in the target vessel were retrospectively analyzed. Results: Cerebral aneurysms were involved in seven patients (2.9%) in the target vessels. Aspiration thrombectomy was first considered; however, five of seven lesions were difficult to manage with aspiration thrombectomy alone. The stent retriever (SR) was combined with aspiration catheter for elongated vessel lesions and distal lesions. In all lesions, good recanalization was achieved without aneurysmal rupture. Conclusion: Aneurysms were identified in 2.9% of LVO in this study. Good recanalization was performed in all cases, and no cerebral aneurysmal rupture was observed during the perioperative period, and the procedure was relatively safe. Further case accumulation is needed for MT device selection and procedures for LVO involving cerebral aneurysm.