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Incidence rate and predictors of recurrent aneurysms after clipping: long-term follow-up study of survivors of subarachnoid hemorrhage

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Abstract

Recurrent aneurysms are a major cause of re-aneurysmal subarachnoid hemorrhage (aSAH), but information on long-term clip durability and predictors is insufficient. This study aimed to present the incidence rate of > 10 years and investigate predictors of a recurrent aneurysm in aSAH survivors. We included 1601 patients admitted with aSAH and treated by microsurgical clipping between January 1993 and May 2010. Of these patients, 435 aSAH survivors were included in this study (27.2%). The total follow-up time was 5680.9 patient-years, and the overall incidence rate was 0.77% per patient-year. The cumulative probability of recurrence without residua and regrowth of the neck remnant was 0.7% and 13.9% at 10 years, respectively. Neck remnant (hazard ratio [HR], 10.311; 95% confidence interval [CI], 5.233–20.313) and alcohol consumption over the moderate amount (HR, 3.166; 95% CI, 1.313–7.637) were independent risk factors of recurrent aneurysm. Current smoking and multiplicity at initial aSAH presentation were significant factors in a univariate analysis. Furthermore, de novo intracranial aneurysms (DNIAs) were more common in the recurrent group than in the non-recurrent group (40.9% vs. 11.5%, P < 0.001). In the present study, we noted the long-term clip durability and predictor of recurrence after microsurgical clipping. These findings can assist clinicians in identifying patients at a high risk of recurrent aneurysm and recommending selective long-term surveillance after microsurgical clipping.

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Funding

This study was supported by a faculty research grant of the Yonsei University College of Medicine (6–2019-0066).

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Authors and Affiliations

  1. Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Hyun Jin Han, Woosung Lee, Keun Young Park & Yong Bae Kim

  2. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Junhyung Kim, Sang Kyu Park & Joonho Chung

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  1. Hyun Jin Han
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  2. Woosung Lee
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  7. Yong Bae Kim
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by HJH, WL, and JK. The first draft of the manuscript was written by HJH, and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Yong Bae Kim.

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This study was approved by the Institutional Review Board of Yonsei University (IRB number: 4–2020-1336).

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Written informed consent for participation was not required for this study owing to its retrospective design.

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Written informed consent for participation was not required for this study owing to its retrospective design.

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Han, H.J., Lee, W., Kim, J. et al. Incidence rate and predictors of recurrent aneurysms after clipping: long-term follow-up study of survivors of subarachnoid hemorrhage. Neurosurg Rev 45, 3209–3217 (2022). https://doi.org/10.1007/s10143-022-01828-x

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