Salvage Strategies for Iatrogenic Rupture Complicating Stent-Assisted Coil Embolization in Middle Cerebral Artery Aneurysms

Objective: To investigate the emergency management strategies and clinical outcomes of iatrogenic rupture, a rare and life-threatening complication, during the interventional treatment of intracranial aneurysms. Methods: We present the case of a 70-year-old female patient who underwent stent-assisted coiling for an unruptured right middle cerebral artery aneurysm. An iatrogenic intraprocedural aneurysm rupture occurred and was successfully managed with salvage therapy. Results: Upon the intraoperative observation of contrast agent extravasation, immediate comprehensive rescue measures were instituted. The core intervention was prompt and ongoing coil embolization to achieve dense packing, supplemented by urgent heparin reversal and controlled hypotension. Postoperatively, the patient developed transient minor neurological dysfunction, which significantly improved following active rehabilitation. One-month follow-up assessment indicated a favorable patient outcome, with a modified Rankin Scale score of 1. Conclusion: In the event of an iatrogenic rupture during stent-assisted coiling, the operator’s composure, accurate judgment, and the implementation of rapid, standardized, comprehensive salvage measures are critical for averting catastrophic consequences and ensuring a favorable patient prognosis. Among these measures, prompt and sustained coil embolization is the most crucial technique for immediate sealing of the rupture site and hemorrhage control.