The authors showed how they coped with thromboembolic complications during the intracranial aneurysm coiling procedure after failed response to medical thrombolysis.

A simple mechanical thrombectomy by using a modification of the Penumbra System was described. Instead of using a typical combination of the separator wire and negative-pressure suction machine, the authors used only a reperfusion catheter and manually created negative pressure within a 20- or 50-cc syringe by pulling the plunger forcefully.The authors also discussed about potential limitations of this procedure.

Rates of thromboembolism in intracranial aneurysm coiling procedure range from 5.9 to 10.4%. Silent infarction is even higher about 60%. Thromboembolic events can be expected during intracranial aneurysm coiling. They can be reduced by a good treatment strategy. A careful preoperative planning is very important especially when treating wide-necked or large aneurysms. In case of using a stent-assisted coiling technique antiplatelet resistant should be anticipated.During the procedure systemic administration of heparin, aspirin,clopidogrel, or glycoprotein IIb-IIIa antagonists is increasingly used to reduce the risk of thromboembolism.

Currently, intraoperative recue therapy in thromboembolic events complicating intracranial aneurysm coiling has been reported using intra-venous and/or intra-arterial abciximab, tirofiban. After refractory to medical thrombolysis, mechanical assistance with the use of a microwire and microcatheters can also be tried. Grade III of the Thrombolysis In Myocardial Infarction or complete recanalization after the rescue procedure ranges from 14.3 to 92%. In this article the authors still get a good recanalization rate after refractory totirofiban injection.