Influence of Intracranial Aneurysms in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy: More Than 10 Years’ Experience in a Tertiary Academic Center

Introduction: The prevalence and impact of intracranial aneurysms (IA) in patients with acute ischemic stroke (AIS) requiring mechanical thrombectomy (MT) is unclear. Here, we aimed to describe the prevalence of IA in patients with AIS and their influence on MT outcomes.

Methods: A retrospective review of prospectively collected database was completed on all patients admitted with a diagnosis of AIS from January 2008 to March 2022. The records were reviewed for demographic, clinical, imaging, and outcomes data. Only patients who had CTA at admission were included in this analysis.

Results: A total of 2265 patients had an admission diagnosis of acute ischemic stroke. AIS was confirmed in 2113 patients (93.3%), 1111 (52.6 %) had head CTA, and 321 (28.9%) underwent endovascular treatment. The observed prevalence of aneurysms on CTA was 4.5% (50/1111) and 8 patients (16%) had multiple aneurysms. MT was performed in 7 patients: 6 had ipsilateral aneurysms and 1 had contralateral aneurysms. In cases with ipsilateral aneurysms, 5 aneurysms were proximal to the occlusion and 1 was distal. The patient with contralateral aneurysm had a TICI 3 score and all aneurysms noted distal to the occlusion were mycotic. In patients with ipsilateral aneurysms, TICI 2B or 3 was achieved in 3 cases (50%), significantly lower than historical controls undergoing MT without IA (372/406) (p=0.01). No aneurysm rupture during MT was observed.

Conclusion : In this analysis, the observed prevalence of IA in patients with AIS was 4.5%. Ipsilateral aneurysms (proximal or distal to the occlusion) deserve particular attention given the potential for rupture during MT. Aneurysms located distal to the occlusion in our population were noted to be mycotic and the rate of revascularization in patients with ipsilateral aneurysms was lower than historical controls. Further studies are needed to improve the outcomes of patients with IA requiring MT.