Background and aims. To assess the technical points of surgical clipping for recurrent aneurysms after coiling, we examine a consecutive series of 14 patients who underwent re-treatment.
Materials and methods. From 2009 to 2016, 27 recurrent aneurysms after coiling were re-treated with endovascular treatment or surgical clipping. Of these, 14 were re-treated surgically. In cases where the remnant neck was sufficiently large, neck clipping was chosen. Where the remnant neck was too small and the border between the thrombosed and non-thrombosed portion was distinct, partial clipping was chosen. Surgical clipping was attempted without removing the coils when technically feasible.
Results. Among the 14 cases, neck clipping was performed in 11, partial clipping in 2, and trapping with bypass in 1 case. Clipping without removal of coils was accomplished in all cases. No neurological deterioration occurred after surgical clipping in any case.
Conclusion. Clipping of recurrent aneurysms after coiling can compensate for the failure of initial endovascular therapy. For clipping without removal of coils, precise evaluation of the remnant neck is required. Bypass surgery is key to treatment in the case of aneurysm trapping.
This is a preview of subscription content, log in to check access.
Conflict of Interests Disclosure
Nothing to report.
Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R, International Subarachnoid Aneurysm Trial Collaborative G. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360:1267–74.CrossRefPubMedGoogle Scholar
Shigematsu T, Fujinaka T, Yoshimine T, Imamura H, Ishii A, Sakai C, Sakai N, Investigators J-N. Endovascular therapy for asymptomatic unruptured intracranial aneurysms: JR-NET and JR-NET2 findings. Stroke. 2013;44:2735–42.CrossRefPubMedGoogle Scholar
Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke. 2007;38:1538–44.CrossRefPubMedGoogle Scholar
Investigators C. Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke. 2006;37:1437–42.CrossRefGoogle Scholar
Molyneux AJ, Kerr RS, Birks J, Ramzi N, Yarnold J, Sneade M, Rischmiller J, Collaborators I. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol. 2009;8:427–33.CrossRefPubMedPubMedCentralGoogle Scholar
Kang HS, Han MH, Kwon BJ, Kwon OK, Kim SH. Repeat endovascular treatment in post-embolization recurrent intracranial aneurysms. Neurosurgery. 2006;58:60–70; discussion 60–70.CrossRefPubMedGoogle Scholar
Slob MJ, Sluzewski M, van Rooij WJ, Roks G, Rinkel GJ. Additional coiling of previously coiled cerebral aneurysms: clinical and angiographic results. AJNR Am J Neuroradiol. 2004;25:1373–6.PubMedGoogle Scholar
van Rooij WJ, Sprengers ME, Sluzewski M, Beute GN. Intracranial aneurysms that repeatedly reopen over time after coiling: imaging characteristics and treatment outcome. Neuroradiology. 2007;49:343–9.CrossRefPubMedGoogle Scholar
Izumo T, Matsuo T, Morofuji Y, Hiu T, Horie N, Hayashi K, Nagata I. Microsurgical clipping for recurrent aneurysms after initial endovascular coil embolization. World Neurosurg. 2015;83(2):211–8.CrossRefPubMedGoogle Scholar
Kai Y, Hamada J, Morioka M, Yano S, Nakamura H, Makino K, Kuratsu J. Re-treatment of patients with embolized ruptured intracranial aneurysms. Surg Neurol. 2008;70:378–85.CrossRefPubMedGoogle Scholar
Romani R, Lehto H, Laakso A, Horcajadas A, Kivisaari R, von und zu Fraunberg M, Niemela M, Rinne J, Hernesniemi J. Microsurgery for previously coiled aneurysms: experience with 81 patients. Neurosurgery. 2011;68:140–53; discussion 153–144.CrossRefPubMedGoogle Scholar
Toyota S, Taki T, Wakayama A, Yoshimine T. Retreatment of recurrent internal carotid-posterior communicating artery aneurysm after coil embolization. Neurol Med Chir (Tokyo). 2015;55:838–47.CrossRefGoogle Scholar
Waldron JS, Halbach VV, Lawton MT. Microsurgical management of incompletely coiled and recurrent aneurysms: trends, techniques, and observations on coil extrusion. Neurosurgery. 2009;64:301–15; discussion 315–317.PubMedGoogle Scholar
Kinouchi H, Yanagisawa T, Suzuki A, Ohta T, Hirano Y, Sugawara T, Sasajima T, Mizoi K. Simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery aneurysms. J Neurosurg. 2004;101:989–95.CrossRefPubMedGoogle Scholar
Toyota S, Taki T, Wakayama A, Yoshimine T. Unruptured internal carotid-posterior communicating artery aneurysm splitting the oculomotor nerve: a case report and literature review. J Neurol Surg Rep. 2014;75:e180–2.CrossRefPubMedPubMedCentralGoogle Scholar
Raabe A, Nakaji P, Beck J, Kim LJ, Hsu FP, Kamerman JD, Seifert V, Spetzler RF. Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg. 2005;103:982–9.CrossRefPubMedGoogle Scholar
Suzuki K, Kodama N, Sasaki T, Matsumoto M, Konno Y, Sakuma J, Oinuma M, Murakawa M. Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery. J Neurosurg. 2003;98:507–14.CrossRefPubMedGoogle Scholar
Tahtinen OI, Manninen HI, Vanninen RL, Rautio R, Haapanen A, Seppanen J, Niskakangas T, Rinne J, Keski-Nisula L. Stent-assisted embolization of recurrent or residual intracranial aneurysms. Neuroradiology. 2013;55:1221–31.CrossRefPubMedGoogle Scholar
Dorfer C, Gruber A, Standhardt H, Bavinzski G, Knosp E. Management of residual and recurrent aneurysms after initial endovascular treatment. Neurosurgery. 2012;70:537–53; discussion 553–554.CrossRefPubMedGoogle Scholar
Bulsara KR, Hoh B, Rosen C, Tanikawa R, Carpenter J. Preliminary observation on predicting the need for coil extraction during microsurgery: the clip-coil ratio. Acta Neurochir. 2010;152:431–4.CrossRefPubMedGoogle Scholar
Lejeune JP, Thines L, Taschner C, Bourgeois P, Henon H, Leclerc X. Neurosurgical treatment for aneurysm remnants or recurrences after coil occlusion. Neurosurgery. 2008;63:684–91; discussion 691–692.CrossRefPubMedGoogle Scholar
Mizoi K, Yoshimoto T, Takahashi A, Nagamine Y. A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery. 1996;39:165–8; discussion 168–169.CrossRefPubMedGoogle Scholar