Objective: To examine the safety and efficacy of mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.
Methods: Between June 2011 and June 2015, 631 consecutive patients with ruptured intracranial aneurysms underwent coil embolization at 6 hospitals. Among 53 patients who had thromboembolic complications, 15 patients harboring 15 aneurysms underwent rescue mechanical thrombectomy with a retrievable stent for the treatment of thromboembolic occlusion during the coiling of ruptured aneurysms. The patients' clinical and radiologic outcomes were retrospectively reviewed.
Results: Of the 15 aneurysms, coiling alone was used for 13 (86.7%), and stent-assisted coiling was performed for 2 (13.3%). Thromboembolic occlusion most frequently occurred distal to the aneurysm (n=10, 66.7%), followed by proximal to the aneurysm (n=3, 20%), and at the coil-parent vessel interface (n=2, 13.3%). All patients underwent mechanical thrombectomy with a retrievable stent, including 5 patients who were initially treated with an IA tirofiban infusion. Complete recanalization (Thrombolysis in Cerebral Infarction (TICI) 3) was obtained in 13 (86.7%) and partial recanalization (TICI 2b) in 2 (13.3%). Two patients who had received IA tirofiban before mechanical thrombectomy had hemorrhagic complications. At 6 months after discharge, 9 patients had a modified Rankin Scale (mRS) score of 1, 3 patients were mRS 2, 1 patient was mRS 3, 1 patient was mRS 4, and 1 patient was mRS 6.
Conclusions: Rescue mechanical thrombectomy using a retrievable stent can be a useful treatment for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.
Keywords: Aneurysm; Coil; Thrombectomy.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.