PMC7265359_01
(a) A computed tomography revealing a subarachnoid hemorrhage. (b) A digital subtraction angiography revealing a right-sided middle cerebral aneurysm. (arrow: aneurysm). (c) A right internal carotid angiography after coil embolization revealing that the aneurysm became neck remnant (open arrow: coil).
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F1
Computed tomography (CT) showed a diffused SAH [Figure 1a]. Digital subtraction angiography (DSA) revealed a right-sided ruptured middle cerebral artery (MCA) aneurysm, 2.3 x 1.9 mm in size [Figure 1b] and a left-sided unruptured MCA aneurysm. After successful coil embolization, the aneurysm transformed into a neck remnant [Figure 1c], with minimal possibility of rerupture.
(a) A right internal carotid angiography revealing the occlusion at the right side of the middle cerebral artery M1 portion. (b) After additional heparin was injected, the clot migrated from M1 to M2 portion.
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F2
After removing the microcatheter, a right internal carotid angiography (ICAG) revealed an occlusion at the proximal right MCA M1 segment [Figure 2a]. The right ICAG showed that the clot had migrated from the M1 to the M2 segment [Figure 2b].
A right internal carotid angiography at the working projection revealing that the stent retriever was deployed in the occluded vessel without covering aneurysmal neck (arrowhead: distal marker of the microcatheter, arrow: stent, open arrow: coil).
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F3
The stent retriever (Solitaire 4 x 20 mm, Medtronic, Minneapolis, MN, USA) was opened in the occluded vessel without covering the aneurysmal neck [Figure 3].
(a) A photograph of the clot as retrieved by the stent. (b) A right internal carotid angiography revealing complete recanalization of the occluded middle cerebral artery. (c) A follow-up computed tomography revealing no hematoma development.
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F4
The stent was withdrawn into the intermediate catheter under continuous mechanical aspiration, and the clot was removed using the stent retriever [Figure 4a]. The ICAG showed complete recanalization (Thrombolysis in Cerebral Infarction Scale 3), and the aneurysm was unaffected [Figure 4b]. A follow-up CT scan showed no aneurysm rerupture [Figure 4c].
(a) A follow-up magnetic resonance image revealing minimal intracerebral infarction and (b) magnetic resonance angiography revealing complete recanalization of the occluded middle cerebral artery.
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F5
Magnetic resonance imaging (MRI) showed minimal intracerebral infarction [Figure 5a] and magnetic resonance angiography showed the remaining recanalization [Figure 5b].