Endovascular coiling of intracranial ruptured aneurysm in pregnancy: Consideration of procedural safety

Aneurysmal subarachnoid hemorrhage during pregnancy is a rare but life-threatening condition associated with high maternal and fetal mortality and an increased risk of rebleeding. We report a 42-year-old woman, gravida 3 para 2, at 18–19 weeks of gestation, who presented with sudden severe headache accompanied by vomiting. Neurological examination showed a Glasgow Coma Scale score of E4V5M6 with positive nuchal rigidity and no motor deficits. Non-contrast computed tomography revealed diffuse subarachnoid hemorrhage suggestive of a ruptured aneurysm, and magnetic resonance angiography confirmed an aneurysm in the right anterior cerebral artery. Cerebral angiography on day 19 identified a saccular aneurysm at the right A1 segment with a 1.29 mm neck and a 3.58 × 3.67 mm dome, directed posteromedial-inferiorly. Endovascular coiling was successfully performed using four coils, with an estimated packing density of 95% and Raymond–Roy Class I occlusion. Fetal protection measures included abdominal shielding, minimized fluoroscopy time, collimation, reduced radiation dose, and the use of low-osmolar iodixanol contrast. Following the procedure, the patient remained clinically stable with reduced headache and no neurological deficits. The pregnancy continued with routine ultrasound monitoring, and cesarean delivery at 36 weeks resulted in a healthy neonate with normal birth weight, Apgar scores of 8 and 9, and no congenital anomalies. This case suggests that endovascular coiling in the second trimester can be feasible and safe when procedural modifications are applied to minimize radiation and contrast exposure while preserving favorable maternal and fetal outcomes.