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

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.