Zero-Delay Mechanical Thrombectomy for Distal Large Vessel Occlusion Detected on Intraoperative Angiogram After Microsurgical Clipping of a Posterior Communicating Artery Aneurysm: Value of Hybrid Operating Room

World Neurosurg. 2018 Nov:119:278-281. doi: 10.1016/j.wneu.2018.08.088. Epub 2018 Aug 23.

Abstract

Background: The hybrid operating room (OR) offers new opportunities for the management of complex cerebrovascular lesions to the dual-trained neurovascular surgeon. It creates a space for easy accessibility to perform complex endovascular procedures by delivering high-quality images with readily available surgical equipment.

Case description: Here, we demonstrate how the hybrid OR allowed for rapid identification and near zero-delay distal mechanical thrombectomy of a middle cerebral artery occlusion with favorable outcome after clipping of a complex posterior communicating artery aneurysm.

Conclusions: Intraoperative cerebral angiography after open surgical clipping of intracranial aneurysms gives real-time actionable data that can affect intraoperative decision making. This can be accomplished without a hybrid OR by using fluoroscopic equipment, but suboptimal imaging conditions may lead to unfavorable outcomes.

Keywords: Intracranial aneurysm; Mechanical thrombectomy; Stroke.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Computed Tomography Angiography*
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / surgery
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / surgery*
  • Microsurgery / instrumentation*
  • Microsurgery / methods*
  • Operating Rooms
  • Thrombectomy / methods*