Rescue mechanical thrombectomy for large vessel occlusion during endovascular treatment of aneurysmal subarachnoid hemorrhage: A case report

Martin Vasilev1; 4; Vladina Dimitrova-Kirilova1; 4; Nora Ivanova2; 4; Tihomir Drenski2; 4; Georgi Todorov3; 5; Chavdar Bachvarov3; 5; Mihael Tsalta-Mladenov2; 4

doi:10.55697/tnd.2026.568

Martin Vasilev^1,4, Vladina Dimitrova-Kirilova^1,4, Nora Ivanova^2,4, Tihomir Drenski^2,4, Georgi Todorov^3,5, Chavdar Bachvarov^3,5, Mihael Tsalta-Mladenov^2,4

¹Department of Optometry and Occupational Diseases, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
²Department of Neurology and Neuroscience, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
³Department of Diagnostic Imaging, Interventional Radiology and Radiotherapy, Medical University "Prof. Paraskev Stoyanov", Varna, Bulgaria
⁴Second Clinic of Neurology with ICU and Stroke Center, University Hospital “St. Marina”, Varna, Bulgaria
⁵Interventional Radiology Center, Imaging Diagnostics Clinic, University Hospital "St. Marina", Varna, Bulgaria

Keywords: Endovascular treatment, mechanical thrombectomy, neurointervention, stroke, subarachnoid hemorrhage.

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening cerebrovascular emergency in which thromboembolic complications during endovascular treatment are rare but potentially devastating. This case report describes a 52-year-old male patient with aSAH caused by rupture of an anterior communicating artery aneurysm who developed an intra-procedural middle cerebral artery occlusion during coil embolization. Rescue mechanical thrombectomy achieved complete recanalization (thrombolysis in cerebral infarction Grade 3) followed by successful aneurysm coiling; however, the patient subsequently developed a large infarction, cerebral edema, and fatal brainstem compression. This case highlights that although rescue thrombectomy can provide technical success when thrombolysis is contraindicated, angiographic recanalization does not necessarily translate into favorable clinical outcomes and emphasizes the need for careful peri-procedural management in patients with combined ischemic and hemorrhagic pathology.

Cite this article as: Vasilev M, Dimitrova-Kirilova V, Ivanova N, Drenski T, Todorov G, Bachvarov C, et al. Rescue mechanical thrombectomy for large vessel occlusion during endovascular treatment of aneurysmal subarachnoid hemorrhage: A case report. Turk J Neurol 2026;32(1):84-91. https://doi.org/10.55697/tnd.2026.568.