Incidental aneurysm rupture during endovascular thrombectomy for acute ischaemic stroke

Acute ischaemic stroke remains a leading cause of disability and mortality worldwide. Treatments include systemic fibrinolysis and more recently, endovascular thrombectomy (EVT). The presence of incidental intracranial aneurysms may increase procedural risk during EVT, particularly given their potential higher prevalence in patients with stroke due to shared risk factors such as smoking and hypertension.We present the case of an elderly woman who experienced rupture of an unrecognised intracranial aneurysm during EVT. This case underscores the importance of meticulous preprocedural imaging review, awareness of high-risk anatomical locations and cautious selection of EVT techniques. We also provide a brief review of the literature regarding the incidence, mechanisms and management of intraprocedural aneurysm rupture.