Pre-emptive Balloon Angioplasty for Asymptomatic Vasospasm to Facilitate Coil Embolization of a Ruptured Middle Cerebral Artery Aneurysm: A Case Report

Endovascular coil embolization of ruptured cerebral aneurysms during vasospasms presents technical and safety challenges. Although balloon angioplasty is typically reserved for symptomatic vasospasms, its use to facilitate endovascular procedures in asymptomatic cases has rarely been reported. We present the case of a 45-year-old man with a four-day history of persistent mild headache. He had undergone coil embolization for left- and right-middle cerebral artery (MCA) aneurysms nine years earlier. On admission, non-contrast computed tomography confirmed a subarachnoid hemorrhage. Digital subtraction angiography revealed a newly ruptured aneurysm at the right MCA bifurcation, along with a segmental vasospasm extending from the right M1 to M2 segments. Although the patient exhibited no neurological deficits, balloon angioplasty was performed to dilate the narrowed artery, thereby facilitating safe microcatheter navigation and reducing the risk of thromboembolic complications during coil embolization. The aneurysm was successfully occluded, and the patient was discharged without any new neurological deficits. This case suggests that, in select patients, balloon angioplasty may be considered to overcome anatomical challenges posed by asymptomatic vasospasm during endovascular treatment of ruptured cerebral aneurysms.