Zero-Delay Mechanical Thrombectomy for Distal Large Vessel Occlusion Detected on Intraoperative Angiogram After Microsurgical Clipping of a Posterior Communicating Artery Aneurysm: Value of Hybrid Operating Room

Background The hybrid operating room (OR) offers new opportunities for the management of complex cerebrovascular lesions to the dual-trained neurovascular surgeon. It creates a space for easy accessibility to perform complex endovascular procedures by delivering high-quality images with readily available surgical equipment. Case Description Here, we demonstrate how the hybrid OR allowed for rapid identification and near zero-delay distal mechanical thrombectomy of a middle cerebral artery occlusion with favorable outcome after clipping of a complex posterior communicating artery aneurysm. Conclusions Intraoperative cerebral angiography after open surgical clipping of intracranial aneurysms gives real-time actionable data that can affect intraoperative decision making. This can be accomplished without a hybrid OR by using fluoroscopic equipment, but suboptimal imaging conditions may lead to unfavorable outcomes.