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
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.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
M.T.M., M.V.: Idea/concept; M.T.M., M.V., N.I., V.D.K.: Design; M.T.M., T.D., G.T., C.B.: Control/supervision; M.V., N.I., T.D., V.D.K., G.T., M.T.M.: Data collection and/or processing; M.T.M., V.D.K., G.T., C.B.: Analysis and/or interpretation; M.V., N.I., V.D.K., M.T.M.: Literature review; M.V., M.T.M.: Writing the article; M.T.M., G.T., C.B.: Critical review.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.