How I do it: coil extraction and clip reconstruction of a previously coiled giant middle cerebral artery aneurysm.

Background: Microsurgical clipping of previously coiled intracranial aneurysms can be technically challenging. We present the case of a 48-year-old female with a partially coiled, previously ruptured giant middle cerebral artery aneurysm and the associated technical nuances.
Methods: We performed a successful coil extraction and clip reconstruction of this aneurysm using an ultrasonic aspirator and stacked fenestrated aneurysm clips.
Conclusion: Coil extraction and clip occlusion of previously coiled intracranial aneurysms is a complex and technically challenging procedure but can be performed safely and effectively when employed judiciously.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, AT part of Springer Nature.)