Endovascular treatment of ruptured intracranial aneurysms during pregnancy: Is this the best way forward? Case report and review of the literature.

Clin Neurol Neurosurg. 2011 Dec 29.
Tarnaris A, Haliasos N, Watkins LD.
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC 1N 3BG, UK.
Abstract
OBJECTIVE AND IMPORTANCE: Subarachnoid haemorrhage in pregnancy has traditionally been treated by surgical clipping however lately cases of successful coiling have been reported. Nevertheless, the long-term outcome of coiling is not well known in pregnant women. Mortality due to rebleeding of an incompletely treated aneurysm remains high. Only 15 cases of successful endovascular coiling during pregnancy have been reported so far.
CLINICAL PRESENTATION: We report the case of a pregnant woman who presented with aneurysmal subarachnoid hemorrhage (WFNS Grade III) due to rupture of a right posterior communicating artery aneurysm.
INTERVENTION: The patient underwent endovascular coiling successfully followed by an elective caesarian section and delivery of a healthy baby. However, during the course of a 2-year follow up the patient had suffered two relapses of the coiled aneurysm which required additional treatment. These events have affected her choice of extending her family.
CONCLUSION: The small risk of recurrence and the potential impact on future pregnancies should be explicitly communicated to patients in cases of endovascular coiling.