Thromboembolic cerebral aneurysms

Intracranial hemorrhage is the most common outcome of cerebral aneurysms, and, therefore, clinical guidelines for the management of patients with cerebral aneurysms are primarily based on assessing the risk of their rupture. Brain ischemia due to the cerebral aneurysms occur significantly less frequently (i.e. in 3–5% of cases), and, in most cases, it is caused by distal embolism with thrombotic masses from large and giant thrombosed aneurysms. A conclusion that ischemic stroke is associated with embolism of thrombi from the aneurysm sac can be made only after ruling out other risk factors, primarily cardioembolism and stenosis of intracranial and extracranial arteries. The management of patients with thromboembolism from aneurysms who developed ischemia is challenging because these patients require antithrombotic agents, which can result in recanalization and rupture of the aneurysm. In addition, the optimal timing for surgery for the aneurysm in the event of acute ischemia has not been determined, given the high risk of recurrent embolism and aneurysm rupture. We present an overview of recent studies on this issue and our experience in managing 4 patients with thromboembolic stroke caused by cerebral aneurysms.