EP59 Successful mechanical thrombectomy after microsurgical clipping of a ruptured middle cerebral artery aneurysm

We report about a 62 year old woman who was brought to the emergency room after being found down at home. On admission she was somnolent but accessible with mild focal neurological deficits. A computed tomography of the brain revealed a right temporal hematoma with subarachnoid and intraventricular hemorrhage due to a ruptured saccular aneurysm of the MCA trifurcation. A surgical approach was considered best treatment option and microsurgical clipping was performed. Intraoperative microvascular Doppler depicted a spontaneous thrombus formation in M1-Segment and the patient was transferred to the angio-suite for a mechanical thrombectomy.Cerebral angiography demonstrated occlusion of the M1-Segment on the right site. After two failed contact aspiration thrombectomy attempts, a combination of stent retriever and aspiration was performed. A microcatheter was advanced into the M2-Segment and a Solitare device was deployed from the middle M2-Artery to M1-Segment.Postthrombectomy imaging demonstrated TICI 2b recanalization. There were no procedure related complications, no perforation and no vasospasm. The treated aneurysm was completely obliterated.Stent-retriever revascularization is a safe, feasible and effective treatment option for acute thrombotic occlusion of the parent artery after microsurgical aneurysm clipping.ReferencesKonakondla S, et al. Zero-delay mechanical thrombectomy for distal large vessel occlusion detected on intraoperative angiogram after microsurgical clippi...
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Treatment Source Type: research