• Fei Xie, Jianqiang Hao, Seidu A Richard, Yuanli Yang, Wuchun Zou, Hong-Bin Liu, Min Deng, and Changwei Zhang.
• Department of Neurosurgery.
• Medicine (Baltimore). 2021 Jan 8; 100 (1): e24239e24239.

RationaleSubarachnoid hemorrhages (SAHs) from ruptured intracranial aneurysms are very rare during pregnancy. Management of ruptured intracranial aneurysms with SAH in pregnancy is often challenging because of the risks to the fetus and the mother. We present the first successful awake endovascular coiling of a dissected intracranial aneurysm in a third trimester twin pregnancy.Patient ConcernsA 28 years' old pregnant woman was admitted at the obstetric department of our hospital on account of very severe headaches associated with nausea and vomiting.DiagnosisEmergency obstetric ultrasound scan done confirmed 32 weeks' twin gestation, whereas magnetic resonance imaging established hemorrhage in the suprasellar cistern and the subarachnoid space. Magnetic resonance angiography revealed a dissected aneurysm in the ophthalmic segment of the left internal carotid artery.InterventionsAwake cerebral angiography as well as embolization of the aneurysm with coils was done via the transarterial route and the twins were delivered via caesarean section at 37 weeks' gestation.OutcomesTwo years' follow-up indicated no complications and children as well as their mother are healthy.LesionsAwake endovascular coiling was very beneficial in our case because we avoided general anesthesia and the use of osmotic diuretics which are potentially hazardous during pregnancy.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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