Background Cerebral aneurysms encounter during mechanical thrombectomy for ischemic stroke can pose a management challenge. Those aneurysms can increase the risk profile of mechanical thrombectomy while carrying a higher risk of rupture intra and post procedurally. The aim of this review is to elucidate practice approaches for patients undergoing mechanical thrombectomy with underlying intracerebral aneurysms.

Methods A search on EMBASE, PUBMED, Google Scholar and SCOPUS. The search algorithm was ‘Mechanical Thrombectomy’ AND ‘Stroke’ AND ‘Aneurysm’ with dates set from 2000 to 2022. The reference lists of selected articles were reviewed for potential citations. Outcomes of interest included rates of procedural rupture, underlying mechanism of stroke, aneurysm treatment strategies.

Results Sixteen reports were included in the review. A total of 33 patients were identified with aneurysms detected during mechanical thrombectomy. 20 aneurysms were within or immediately proximal to the target vessel for mechanical thrombectomy, 9 of which had procedural rupture. Mechanism of stroke was thought to be extension of spontaneous thrombosis in 8 cases. Use of an aspiration first approach as opposed to SR was suggested as possible technique that may mitigate hidden aneurysm rupture.

Conclusion Aneurysm rupture during mechanical thrombectomy is associated with significant mortality and morbidity. Although rare, spontaneous aneurysm thrombosis is a potential mechanism of stroke and can carry an increased risk of aneurysmal rupture. Mechanisms of procedural rupture include stentriever or wire manipulation in an occult aneurysm and tractional forces in areas of aneurysm adhesion. Aspiration alone and the use of J shaped wires are technical considerations that can potentially decreased the possibility of aneurysm rupture in mechanical thrombectomy.

Disclosures Y. Radaideh: None. K. Joshi: None. J. Gerzenshtein: None. M. Chen: None.