9V battery-powered microguidewire electrocoagulation and flow diversion for salvage of recurrent supraclinoid aneurysm.

Abstract

Microguidewire electrocoagulation, an alternative when microcatheterization is not feasible, has been reported in sporadic cases, almost exclusively limited to tiny, extremely narrow-necked aneurysms.1-10 However, it has not been described for recurrent wide-necked aneurysms following braided stent-assisted coiling.A woman in her 40s presented with Hunt-Hess grade 4 subarachnoid hemorrhage from a ruptured dorsal supraclinoid internal carotid artery aneurysm. Emergency braided stent-assisted coiling was complicated by significant recurrence at 3 weeks. COVID-19 restrictions prevented interhospital transfer and rendered dedicated electrocoagulation devices unavailable. Salvage treatment was performed by connecting a loop-tipped microguidewire to a common 9 volt battery for electrocoagulation, followed by Tubridge flow diverter deployment. Complete aneurysm occlusion was confirmed at 18-month angiography. The patient survived and remained neurologically stable without new deficits, although severely disabled (video 1). This improvised technique achieved durable aneurysm occlusion and may be considered a last-resort bailout in resource-limited emergency scenarios.neurintsurg;jnis-2026-025979v1/V1F1V1Video 1Technical video demonstrating 9-volt battery-powered microguidewire electrocoagulation and flow diversion for salvage of recurrent supraclinoid aneurysm.