Management of Residual and Recurrent Aneurysms After Clipping or Coiling: Clinical Characteristics, Treatments, and Follow-Up Outcomes

• Published in: World neurosurgery Vol. 122; pp. e838 - e846
• Main Authors: Yu, Le-Bao, Fang, Zhi-Jun, Yang, Xin-Jian, Zhang, Dong
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2019
• Subjects: Adolescent; Adult; Aged; Disease Management; Endovascular coiling; Endovascular Procedures - methods; Female; Follow-Up Studies; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Male; Microsurgery - methods; Microsurgical clipping; Middle Aged; Recurrence; Recurrent aneurysm; Retrospective Studies; Surgical Instruments; Treatment Outcome; Young Adult; ACoA; Recurrent aneurysm; Endovascular coiling; Microsurgical clipping; RA
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.10.160

Recurrent intracranial aneurysms (RAs) remain a daunting challenge for neurosurgeons. This study aimed to explore a potential optimal management strategy of RAs by reviewing the characteristics and management outcomes of 117 RAs. A total of 117 patients with RAs were treated in a single neurosurgical center from January 2011 to January 2017. The demographic and angiographic characteristics of the patients, treatment approaches, and follow-up outcomes were evaluated. Of the 117 patients with RAs, 16 (13.7%) and 101 (86.3%) initially underwent microsurgical clipping and endovascular coiling, respectively. Coil embolization was used in 75 cases, microsurgical clipping was used in 32 cases, and conservative treatment occurred in 10 cases. Complete clipping was achieved in all 32 aneurysms by microsurgery, and remnants were observed in 25 aneurysms after coiling (33.3%, P < 0.001). Operation-related cerebral infarction occurred in 4 cases (12.5%) with complex and large RA in the clipping group and in 1.3% (1/75) of patients treated with coiling (P = 0.027). Follow-up found similar favorable outcomes in patients after coiling, clipping, and conservative treatment (90.3% vs. 86.7% vs. 80%, respectively; P = 0.711). Follow-up rates of recurrence were significantly higher in the coiling group than the clipping group (26% vs. 0%, respectively; P = 0.003). The follow-up outcomes appeared to be acceptable and comparable between the 2 groups. However, in large or giant recurrent aneurysms, sound judgment and the careful selection of treatment are strongly suggested because direct microsurgery has a higher morbidity, even in experienced hands, whereas endovascular coiling is complicated with a higher incomplete occlusion rate.