Endovascular treatment of ruptured middle cerebral artery aneurysm in a pregnant woman

Aneurysms of the cerebral vessels are disorders in the structure of the walls of cerebral arteries. They usually occur in large arteries in the base of the brain. Pressure on nerves, which is the result of the presence of aneurysms, may lead to various types of neurological disorders [1]. Subarachnoid haemorrhage (SAH) is a complication of a ruptured aneurysm. The symptoms accompanying SAH may include: strong headache (frequently described by patients as ‘thunderclap headache’), disturbances of consciousness, nausea, vomiting, and loss of consciousness [2, 3].
The development of modern neurosurgical and neuroradiological endovascular treatment methods has allowed less invasive management of aneurysms, thereby decreasing the risk of complications, compared to the classic neurosurgical procedures [4].
Embolisation consists of percutaneous, intravascular introduction of self-detached coils into the aneurysmal sac, sometimes with the use of stents or balloons for remodelling via the system of catheters and microcatheters, through femoral artery access. This surgical technique leads to the exclusion of the aneurysm from the circulation and restores normal cerebral blood flow. One of the complications of embolisation is a thromboembolic episode occurring as a result of irritation of the vascular endothelium and triggering of the clotting cascade [5].
The objective of the study was the presentation of the case of a patient in pregnancy with ruptured aneurysm of the middle cerebral artery, with secondary coagulation of the middle cerebral artery and an effective mechanical thrombectomy.
A 33-year-old patient, in week 34 of pregnancy, was referred from a district hospital to the Provincial Hospital in Kielce due to subarachnoid haemorrhage from a ruptured aneurysm of the right middle cerebral artery, with accompanying intracerebral haematoma in the right temporal lobe, diagnosed in magnetic resonance angiogram (MRI). At admission, in neurological examination, 15 points according to the GCS scale were diagnosed, positive meningeal signs expressed by a considerable stiffness of the neck; mild left-sided hemi-paresis. After neurological, neurosurgical, and gynaecological consultations, the patient was qualified for endovascular treatment in the Clinic for Neurosurgery and Spine Surgery, following previous termination of pregnancy under general anesthesia with delivery of a live male newborn. Directly after delivery, the patient was transported...


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