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Case series
Rescue mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms
  1. Jun Hyong Ahn1,
  2. Hyo Sub Jun2,
  3. Joon Ho Song1,
  4. Byung Moon Cho3,
  5. Ho Kook Lee4,
  6. Byong-Cheol Kim5,
  7. Dong-Keun Hyun6,
  8. In Bok Chang1
  1. 1Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
  2. 2Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Korea
  3. 3Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
  4. 4Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
  5. 5Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea
  6. 6Department of Neurosurgery, Inha University Hospital, Incheon, Korea
  1. Correspondence to In Bok Chang, Department of Neurosurgery, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do 431-070, South Korea; nscib71{at}gmail.com

Abstract

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.

  • Thrombectomy
  • Aneurysm
  • Coil

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