Acute posterior circulation stroke during chimney-endovascular aneurysm repair successfully treated with posterior cerebral artery thrombaspiration: A case report.

Intraoperative stroke is a rare but devastating complication during endovascular aneurysm repair (EVAR). We report a case of acute posterior cerebral artery thrombosis during chimney EVAR successfully managed with endovascular thrombaspiration. This case highlights the importance of immediate recognition and neurointerventional response to achieve favorable neurological outcomes. A 70-year-old man underwent urgent chimney EVAR for a ruptured abdominal aortic aneurysm. Shortly after completion of the procedure, the patient developed acute neurological symptoms. Emergency cerebral angiography revealed basilar and posterior cerebral artery thrombosis. Selective thrombaspiration via left vertebral artery access using Penumbra ACE 68 successfully restored flow. The patient fully regained consciousness after the intervention. Prompt recognition and immediate neurointerventional management of acute stroke during EVAR can lead to favorable outcomes. This case highlights the importance of a multidisciplinary approach and endovascular preparedness in hybrid operating room settings.