Mechanical thrombectomy for treatment of thromboembolic complication before coiling of the ruptured intracranial aneurysms

Background & Objective: During aneurysm embolization procedure, the occurrence of arterial embolism before the coil packing is rare and less reported. This study aimed to evaluate the safety and efficiency of mechanical thrombectomy in the treatment of thromboembolic complication before aneurysm coiling in the ruptured aneurysm embolization procedure.Methods: Between January 2010 and December 2021, 426 patients with ruptured intracranial aneurysms were treated with endovascular embolization in our hospital. Out of them, 5 patients were found to have thromboembolic event at the ipsilateral arteries of the aneurysm before coiling of the aneurysms. We used mechanical thrombectomy to recanalize the occluded arteries, followed by coiling of the aneurysms. We retrospectively analyzed the clinical and imaging data of the patients, and the safety and efficiency of the therapeutic regime was evaluated. Results: The occluded arteries were successfully recanalized with mechanical thrombectomy and the ruptured aneurysms were successfully treated by simple coiling or stent-assisted coiling. No severe operation-correlated complications occurred during the procedures. Postoperative imaging showed 1 case of cerebral infarction in thromboembolic area. One patients had motor aphasia, and the other 4 cases had no significant neurologic deficits compared to before operation. At the time of discharge, the mRS score was 2 in 1 patient, 1 in 1 and 0 in 3; and at 3 months after operation, the mRS score was 2 in 1 patient and 0 in 4.Conclusions: For patients with ruptured aneurysm, thromboembolic event before aneurysm coiling is rare. Mechanical thrombectomy followed by coiling of the aneurysms is a safe and reasonable treatment regime, which may improve the prognosis of patients.