Key result
Delayed postpartum endovascular coiling shrinks giant vertebral artery aneurysm by ~36% and resolves neurological symptoms.
Why the study?
Intracranial aneurysms during pregnancy pose diagnostic and therapeutic challenges due to increased rupture risk and physiological changes, requiring careful management.
Case Report (n=1)
Delaying endovascular intervention until postpartum may be safe and effective for managing giant vertebral artery aneurysms in pregnant patients when clinically stable.
May support delayed postpartum coiling in stable pregnant patients with giant vertebral aneurysms; hypothesis-generating and requires validation in larger cohorts.
INTRODUCTION AND IMPORTANCE: Intracranial aneurysms, especially giant basilar artery aneurysms, pose significant diagnostic and therapeutic challenges due to their deep location and high rupture risk. During pregnancy, physiological changes such as increased blood volume and hormonal fluctuations further elevate the risk, making timely diagnosis and management critical to ensure maternal and fetal safety. CASE PRESENTATION: We present a case of a 23-year-old woman at 28 weeks of gestation who reported severe occipital headache, vomiting, and photophobia. MRI revealed a 4.4 cm giant thrombosed right vertebral artery (V4 segment) aneurysm. Digital subtraction angiography confirmed the diagnosis. To minimize fetal risk, definitive endovascular intervention was deferred until two months postpartum. She was closely monitored throughout pregnancy and delivered without complications. CLINICAL DISCUSSION: Two months postpartum, cerebral angiography showed aneurysmal progression, and endovascular coiling with segment sacrifice was successfully performed. Follow-up CT at three months demonstrated aneurysm reduction to 2.8 cm and progressive calcification, suggesting chronic stabilization. The patient's neurological symptoms resolved, with no new deficits. Dual antiplatelet therapy was initiated post-procedure. CONCLUSION: This case highlights the importance of a multidisciplinary approach and tailored management in pregnant patient with cerebral aneurysms. Delaying intervention until postpartum may be safe and effective when clinical stability allows, reinforcing the role of individualized care strategies in optimizing maternal and fetal outcomes.
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Khamaysa et al. (2025) conducted a case report in Giant thrombosed vertebral artery aneurysm in pregnancy (n=1). Delayed endovascular coiling with segment sacrifice was evaluated on Aneurysm reduction and clinical stabilization. Delayed endovascular coiling performed two months postpartum successfully reduced a 4.4 cm giant thrombosed vertebral artery aneurysm to 2.8 cm, with complete resolution of neurological symptoms.
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