Objectives: To describe a series of patients with stroke secondary to thrombosis in unruptured non-giant aneurysms and to classify them.
Methods: Patients with saccular non-giant aneurysm thrombosis presenting with ischemic events were identified. The clinical and imaging attributes were then used to build a novel classification scheme for aneurysm-related stroke.
Results: Six patients were included representing 0.15% of all strokes. The proposed mechanisms for stroke were classified as dislodgement of aneurysm thrombi to distal vessels, extension of aneurysm clot into the parent vessel and parent vessel occlusion due to extrinsic compression by the thrombosed aneurysm. Stroke severity was minor and outcome was excellent in all patients.
Conclusions: Strokes caused by unruptured aneurysms are rare and can be caused by several mechanisms. Clinicians should be aware of this rare form of stroke as it may represent a contraindication to systemic thrombolysis due to increased risk of aneurysm recanalization and rupture.