Delayed intervention for a giant thrombosed vertebral artery aneurysm in pregnancy: A case report.

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.