Mechanical thrombectomy for M2 occlusion sharply branching from M1 near an aneurysm

Background: Mechanical thrombectomy (MT) for vessel occlusion near an aneurysm carries the risk of aneurysm rupture due to mechanical stress during the procedure. We report a case of MT performed for M2 occlusion that sharply branched from M1 near the aneurysm. Case Description: A 73-year-old woman presented with a left middle cerebral artery (MCA) bifurcation aneurysm, exhibiting right-sided hemiparesis and aphasia. MT was performed for M2 occlusion, which sharply branched from M1 near the MCA bifurcation aneurysm. Lesion crossing was carefully performed, and a stent retriever was deployed at the occlusion site. Using a stent retriever as an anchor, a bent-tip aspiration catheter was guided past the aneurysm to the proximal end of the thrombus. A combined technique, during which the stent retriever was retracted into the aspiration catheter, was used. This approach minimized mechanical stress on the aneurysm and helped achieve effective recanalization. Conclusion: In cases of vessel occlusion with a proximal cerebral aneurysm, a combined technique of retracting a stent retriever into an aspiration catheter positioned distal to the aneurysm after stent retriever deployment may help reduce the mechanical stress on the aneurysm during MT and provide a safer approach.