Delayed Rupture of an Anterior Communicating Artery Pseudoaneurysm Caused by Distal Occlusion Thrombectomy Using a Stent Retriever: A Case Report and Mechanism of Injury

Abstract

We report a case of delayed rupture of an anterior communicating artery (Acom) pseudoaneurysm following mechanical thrombectomy (MT) of a distal artery occlusion using a stent retriever. An elderly patient with right hemiparesis showed left proximal internal cerebral artery and middle cerebral artery occlusions. During MT, a fragmented thrombus moved to the anterior cerebral artery (ACA). A stent retriever was deployed to the occluded ACA, and the Acom and proximal ACA segment were significantly straightened. Additionally, we attempted a blind exchange mini-pinning (BEMP) technique, but a subarachnoid hemorrhage (SAH) occurred. Bleeding was almost entirely absorbed 9 days after the procedure, but the SAH recurred at 20 days, and computed tomography angiography revealed a new pseudoaneurysm formation in the Acom. We suggest that the proposed mechanism of pseudoaneurysm formation was likely due to the dislocation and avulsion of the Acom perforators when the ipsilateral ACA was pushed and pulled during MT.

Delayed Rupture from a Pseudoaneurysm after Mechanical Thrombectomy: A Case Report

“…Treatment included endovascular treatment in two cases, 3,5 open surgery in three cases, 4,6 and conservative treatment in one case. 7 Open surgery has the advantage of more complete treatment of the pseudoaneurysm and removal of the hematoma. The outcomes were poor, one patient died 7 and five patients experienced hemiparesis and aphasia.…”

“…7 Open surgery has the advantage of more complete treatment of the pseudoaneurysm and removal of the hematoma. The outcomes were poor, one patient died 7 and five patients experienced hemiparesis and aphasia. [3][4][5][6] Procedure-related SAH after MT has been reported as a benign clinical feature that does not require additional surgical procedures.…”

“…In previous reports, pseudoaneurysm formation after MT has been reported in six cases, including our case, four following stent retriever usage, one following the aspiration method, and one following the stent retriever and aspiration method ( Table 1 ). 3 4 5 6 7 The mechanisms were direct injury from the aspiration method or microcatheter, 3 dissection of unknown cause, 5 and avulsion of small vessels resulting from the stent retriever method. 4 6 7 Therefore, care should also be taken to avoid these complications during the procedure.…”

“…Pseudoaneurysms associated with endovascular procedures are rare but can occur after MT in cases with vessel injury. [3][4][5][6][7] In this case report, we present a case of delayed rebleeding from a pseudoaneurysm after MT with a stent retriever confirmed by open surgery.…”

“…Pseudoaneurysms associated with endovascular procedures are rare but can occur after MT in cases with vessel injury. 3 4 5 6 7…”