Endovascular Thrombectomy for Large-Vessel Occlusion Strokes with Preexisting Intracranial Aneurysms

Zhou, Tengfei; Li, Tianxiao; Zhu, Ling; Wang, Ziliang; Bai, Weixing; Xue, Jiangyu; Gao, Feng

doi:10.1007/s00270-018-1945-9

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Patients with AIS eligible for MT have a higher prevalence of cerebral aneurysm (3.7%) than a healthy reference population. [23][24][25] FPD CT angiographic imaging thus appeared useful for the planning of appropriate treatment strategies, considering anatomic details that need careful attention.…”

Section: Discussionmentioning

confidence: 99%

Distal Vessel Imaging via Intra-arterial Flat Panel Detector CTA during Mechanical Thrombectomy

Nozaki

Noda²,

Ishibashi

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Obtaining information on invisible vasculature distal to the occlusion site helps to deploy a stent retriever safely during mechanical thrombectomy for large-vessel occlusion. It is essential to reduce the amount of contrast used for detecting the vessels distal to the occlusion site because acute ischemic stroke patients tend to have chronic kidney disease and patients with severe chronic kidney disease are at an increased risk of contrast-associated acute kidney injury. We assessed whether vessels distal to the occlusion site during acute ischemic stroke with large-vessel occlusion could be visualized on angiographic images using flat panel detector CT acquired following intra-arterial diluted contrast injection, compared with MRA findings. MATERIALS AND METHODS:Between May 2019 and January 2020, we enrolled 28 consecutive patients with large-vessel occlusions of the anterior circulation eligible for mechanical thrombectomy following MR imaging. The patients underwent CBV imaging using flat panel detector CT with an intra-arterial diluted contrast injection instead of intravenous injection. Flat panel detector CT angiographic images reconstructed from the same dataset were evaluated for image quality, collateral status of the MCA territory, and visualization of the vessels distal to the occlusion site. These findings were compared with MRA findings. RESULTS:Twenty-two patients were retrospectively examined. Flat panel detector CT angiographic image quality in 20 patients (91%) was excellent or good. The distal portion of the occluded vessel segment was visualized in 14 patients (70%), while the proximal portion of the segment adjacent to the occluded vessel in 3 (15%) was visualized. No visualization was observed in only 1 patient (5%) with no collateral supply. Flat panel detector CT angiographic images were shown to evaluate vessels distal to the occlusion site more accurately than MRA. CONCLUSIONS:In acute ischemic stroke with large-vessel occlusion, flat panel detector CT angiographic images could successfully visualize vessels distal to the occlusion site with a small amount of contrast material.

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Section: Discussionmentioning

confidence: 99%

Distal Vessel Imaging via Intra-arterial Flat Panel Detector CTA during Mechanical Thrombectomy

Nozaki

Noda²,

Ishibashi

et al. 2020

AJNR Am J Neuroradiol

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“…Cases complicated by vascular abnormality other than twig-like MCA in a region distal to major cerebral artery occlusion have been reported. In cases of major cerebral artery occlusion, the frequency of occlusion accompanied by unruptured cerebral aneurysm distal to the occluded region discovered during the procedure was 0.8% (1/124) 14) to 1% (3/300) 15) and that of aneurysm rupture-induced hemorrhagic complication observed during thrombus retrieval was 0.3% (1/300) 15) to 0.8% (1/124). 14) To our knowledge, there has been no report of arteriovenous malformation or moyamoya observed at a site distal to the occluded region during the procedure.…”

Section: Discussionmentioning

confidence: 97%

Mechanical Thrombectomy for ICA Top Occlusion with Twig-Like MCA: A Case Report

Sakai

Yoshikawa

Sato

2022

JNET

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We report a case of hemorrhagic complication after mechanical thrombectomy (MT) for internal carotid artery (ICA) occlusion with twig-like middle cerebral artery (MCA).Case Presentation: A 75-year-old man was admitted to our hospital with ICA occlusion. Recanalization was achieved by a direct aspiration first pass technique (ADAPT). The peripheral MCA was twig-like, but operators thought that a thrombus remained in the MCA first segment. The procedure was continued and suspended with perforation of the microguidewire. Conclusion:When performing MT for large vessel occlusion (LVO) with twig-like MCA, it is difficult to proceed a device to the periphery and there is a risk of hemorrhage.

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“…In the case series by Zhou et al . including 124 patients,[ 9 ] SAH due to the rupture of an aneurysm was observed in 1 patient (0.8%), and in this patient, a causal relationship between aneurysm rupture (basilar artery) and stent use (the occluded MCA) did not exist. Our case of a ruptured hidden aneurysm distal to the occlusion site while performing MT was the only one among 119 MTs (0.8% prevalence) in over 4 years, indicating that our results are similar to findings in previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…There are few reports about the prevalence of aneurysms in AIS patients who underwent MT[ 9 , 10 ] or embolectomy[ 3 ] by open craniotomy for LVO, and the prevalence of aneurysm-related vessel occlusion is at 3.7–7.2% not low. However, cases of aneurysms that are undetected before MT and hidden distal to the occlusion site or causing SAH by their rupture may be rare.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with cerebral aneurysm suffering from acute ischemic stroke (AIS) were found to have a prevalence of 5.6% according to a recent study (in a population of 127 AIS patients), which was higher than the worldwide prevalence, calculated in healthy reference populations (from over 20 countries with no comorbidities and an average age of 50 years). [ 7 , 9 ] During mechanical thrombectomy (MT), aneurysm ruptures may have catastrophic outcomes, since using a stent retriever for AIS patients with large-vessel occlusion (LVO) is often performed in combination with intravenous tissue plasminogen activator (IV tPA). Particularly, an unknown hidden aneurysm poses a potential danger in recanalization attempts because its detection before MT is difficult.…”

Section: Introductionmentioning

confidence: 99%

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Ruptured hidden intracranial aneurysm during mechanical thrombectomy: A case report

Nozaki

Noda²,

Ishibashi

et al. 2020

Surgical Neurology International

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Background: Acute ischemic stroke (AIS) patients have a higher prevalence of cerebral aneurysm than a healthy reference population. However, it was recently reported that cases of an unknown hidden aneurysm in AIS patients with large-vessel occlusion are rare. We report a rare case of subarachnoid hemorrhage (SAH) during mechanical thrombectomy (MT) using a stent retriever for AIS. Case Description: A 46-year-old patient with the right internal carotid artery terminal occlusion presented with the left-sided hemiparesis, hemispatial neglect, and dysarthria and underwent MT. Initial thrombectomy using a stent retriever and reperfusion catheter was unsuccessful. Angiography just before the second attempt showed SAH. Fortunately, we achieved recanalization of the thrombolysis in cerebral infarction 2b and hemostasis by lowering the blood pressure followed by coil embolization of the ruptured aneurysm. Only a few cases of ruptured aneurysms have been reported during MT using a stent retriever. Stent withdrawal is suspected to cause aneurysm rupture in cases with an unknown hidden middle cerebral artery bifurcation aneurysm. Conclusion: Preinterventional detection of a hidden aneurysm is difficult. Therefore, surgeons must always consider the possibility of a hidden aneurysm rupture in vessels distal to the occlusion site and make adequate preparations for the prompt treatment of ruptured aneurysms after MT.

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Endovascular Thrombectomy for Large-Vessel Occlusion Strokes with Preexisting Intracranial Aneurysms

Cited by 8 publications

References 16 publications

Distal Vessel Imaging via Intra-arterial Flat Panel Detector CTA during Mechanical Thrombectomy

Distal Vessel Imaging via Intra-arterial Flat Panel Detector CTA during Mechanical Thrombectomy

Mechanical Thrombectomy for ICA Top Occlusion with Twig-Like MCA: A Case Report

Ruptured hidden intracranial aneurysm during mechanical thrombectomy: A case report

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