Management of ruptured hidden mirror intracranial aneurysm during mechanical thrombectomy

Abstract A 55-year-old woman with acute ischaemic stroke was referred for endovascular treatment after unsuccessful intravenous thrombolysis. Her initial National Institutes of Health Stroke Score (NIHSS) was 20. The right carotid artery stenting was performed because of the inappropriate result of angioplasty of the right internal carotid artery stenosis at origin, followed by recanalization of right internal carotid and middle cerebral arteries. Periprocedural rupture of the wide-neck right bifurcation middle cerebral artery (MCA) aneurysm occurred. Computed tomography (CT) scan confirmed subarachnoid haemorrhage without intracerebral hematoma. Subsequently, the aneurysm was successfully treated by stent-assisted coiling technique. The patient recovered completely and no residual neurological deficit was present 1 month after the treatment. Retrospective CT angiography evaluation unveiled the presence of a small contralateral MCA mirror aneurysm.