Skip to main content
SpringerLink
Log in

Recurrent/Residual Aneurysms

  • Chapter
  • First Online:
Eight Aneurysms

  • 288 Accesses

Abstract

Recurrent aneurysm after surgical clipping and endovascular embolization is common. The treatment strategies are variable depending on the scenario. No consensus on when and how to treat the recurrent aneurysm is reached in practice. Recurrent rate and natural history of recurrent/residual aneurysm after different treatment methods are reviewed from the literature. The mechanisms of recurrence and timing of treatment are also discussed. The strategies of embolization for different situations as below are described:

  1. 1.

    Recurrent/residual aneurysms after primary coiling without stenting.

  2. 2.

    Previously stented recurrent/residual aneurysms.

  3. 3.

    Flow-diverter stent-treated residual aneurysm.

  4. 4.

    Recurrence/residual after surgical clipping.

  5. 5.

    Recurrence/residual after intrasaccular flow diversion device treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Dorfer C, Gruber A, Standhardt H, Bavinzski G, Knosp E. Management of residual and recurrent aneurysms after initial endovascular treatment. Neurosurgery. 2012;70(3):537–53. discussion 553-534

    Article  PubMed  Google Scholar 

  2. Li H, Gao BL, Li CH, Wang JW, Liu JF, Yang ST. Endovascular retreatment of cerebral aneurysms previously treated with endovascular embolization. J Neurol Surg A Cent Eur Neurosurg. 2020;81(3):207–12.

    Article  PubMed  Google Scholar 

  3. Bernat AL, Clarencon F, Andre A, et al. Risk factors for angiographic recurrence after treatment of unruptured intracranial aneurysms: outcomes from a series of 178 unruptured aneurysms treated by regular coiling or surgery. J Neuroradiol. 2017;44(5):298–307.

    Article  PubMed  Google Scholar 

  4. Chalouhi N, Tjoumakaris S, Gonzalez LF, et al. Coiling of large and giant aneurysms: complications and long-term results of 334 cases. AJNR Am J Neuroradiol. 2014;35(3):546–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Greve T, Sukopp M, Wostrack M, Burian E, Zimmer C. Friedrich B. Clin Neuroradiol: Initial Raymond-Roy Occlusion Classification but not Packing Density Defines Risk for Recurrence after Aneurysm Coiling; 2020.

    Google Scholar 

  6. Kang HS, Han MH, Kwon BJ, Kwon OK, Kim SH. Repeat endovascular treatment in post-embolization recurrent intracranial aneurysms. Neurosurgery. 2006;58(1):60–70. discussion 60-70

    Article  PubMed  Google Scholar 

  7. Cognard C, Weill A, Spelle L, et al. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology. 1999;212(2):348–56.

    Article  CAS  PubMed  Google Scholar 

  8. Molyneux AJ, Kerr RS, Yu LM, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809–17.

    Article  PubMed  Google Scholar 

  9. Molyneux AJ, Kerr RS, Birks J, et al. 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(5):427–33.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Molyneux A, Kerr R, Stratton I, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360(9342):1267–74.

    Article  PubMed  Google Scholar 

  11. Mascitelli JR, Oermann EK, De Leacy RA, Moyle H, Patel AB. Angiographic outcome of intracranial aneurysms with neck remnant following coil embolization. J Neurointerv Surg. 2015;7(7):484–9.

    Article  PubMed  Google Scholar 

  12. Mendenhall SK, Sahlein DH, Wilson CD, et al. The natural history of coiled cerebral aneurysms stratified by modified Raymond-Roy occlusion classification. World Neurosurg. 2019;128:e417–26.

    Article  PubMed  Google Scholar 

  13. Daou B, Starke RM, Chalouhi N, et al. The use of the pipeline embolization device in the Management of Recurrent Previously Coiled Cerebral Aneurysms. Neurosurgery. 2015;77(5):692–7. discussion 697

    Article  PubMed  Google Scholar 

  14. Chalouhi N, Chitale R, Starke RM, et al. Treatment of recurrent intracranial aneurysms with the pipeline embolization device. J Neurointerv Surg. 2014;6(1):19–23.

    Article  PubMed  Google Scholar 

  15. 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(8):1373–6.

    PubMed  PubMed Central  Google Scholar 

  16. Park HK, Horowitz M, Jungreis C, et al. Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol. 2005;26(3):506–14.

    PubMed  PubMed Central  Google Scholar 

  17. Investigators C. Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke. 2006;37(6):1437–42.

    Article  Google Scholar 

  18. Han Y, Liu J, Tian Z, et al. Factors affecting recurrence and management of recurrent cerebral aneurysms after initial coiling. Interv Neuroradiol. 2020;26(3):300–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Raymond J, Guilbert F, Weill A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34(6):1398–403.

    Article  PubMed  Google Scholar 

  20. Yu SC, Kwok CK, Cheng PW, et al. Intracranial aneurysms: midterm outcome of pipeline embolization device--a prospective study in 143 patients with 178 aneurysms. Radiology. 2012;265(3):893–901.

    Article  PubMed  Google Scholar 

  21. Kulcsar Z, Ernemann U, Wetzel SG, et al. High-profile flow diverter (silk) implantation in the basilar artery: efficacy in the treatment of aneurysms and the role of the perforators. Stroke. 2010;41(8):1690–6.

    Article  PubMed  Google Scholar 

  22. Gawlitza M, Januel AC, Tall P, Bonneville F, Cognard C. Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: a single-center series with special emphasis on covered cortical branches and perforating arteries. J Neurointerv Surg. 2016;8(5):481–7.

    Article  PubMed  Google Scholar 

  23. Michelozzi C, Darcourt J, Guenego A, et al. Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: complications, aneurysm sac occlusion, reabsorption, recurrence, and jailed branch modification at follow-up. J Neurosurg. 2018;131(6):1751–62.

    Article  PubMed  Google Scholar 

  24. Yavuz K, Geyik S, Saatci I, Cekirge HS. Endovascular treatment of middle cerebral artery aneurysms with flow modification with the use of the pipeline embolization device. AJNR Am J Neuroradiol. 2014;35(3):529–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Pistocchi S, Blanc R, Bartolini B, Piotin M. Flow diverters at and beyond the level of the circle of Willis for the treatment of intracranial aneurysms. Stroke. 2012;43(4):1032–8.

    Article  PubMed  Google Scholar 

  26. Saleme S, Iosif C, Ponomarjova S, et al. Flow-diverting stents for intracranial bifurcation aneurysm treatment. Neurosurgery. 2014;75(6):623–31. quiz 631

    Article  PubMed  Google Scholar 

  27. Zanaty M, Chalouhi N, Tjoumakaris SI, Gonzalez LF, Rosenwasser R, Jabbour P. Flow diversion for complex middle cerebral artery aneurysms. Neuroradiology. 2014;56(5):381–7.

    Article  PubMed  Google Scholar 

  28. Saatci I, Yavuz K, Ozer C, Geyik S, Cekirge HS. Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results. AJNR Am J Neuroradiol. 2012;33(8):1436–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Guedon A, Clarencon F, Di Maria F, et al. Very late ischemic complications in flow-diverter stents: a retrospective analysis of a single-center series. J Neurosurg. 2016;125(4):929–35.

    Article  PubMed  Google Scholar 

  30. Wang CB, Shi WW, Zhang GX, Lu HC, Ma J. Flow diverter treatment of posterior circulation aneurysms. A meta-analysis Neuroradiology. 2016;58(4):391–400.

    PubMed  Google Scholar 

  31. Piotin M, Blanc R, Spelle L, et al. Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke. 2010;41(1):110–5.

    Article  PubMed  Google Scholar 

  32. Chalouhi N, Jabbour P, Singhal S, et al. Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke. 2013;44(5):1348–53.

    Article  PubMed  Google Scholar 

  33. Aguilar-Salinas P, Brasiliense LB, Santos R, et al. Safety and efficacy of stent-assisted coiling in the treatment of Unruptured wide-necked intracranial aneurysms: a single-center experience. Cureus. 2019;11(6):e4847.

    PubMed  PubMed Central  Google Scholar 

  34. Daou B, Starke RM, Chalouhi N, et al. Pipeline embolization device in the treatment of recurrent previously stented cerebral aneurysms. AJNR Am J Neuroradiol. 2016;37(5):849–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Fischer S, Vajda Z, Aguilar Perez M, et al. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012;54(4):369–82.

    Article  PubMed  Google Scholar 

  36. Bender MT, Vo CD, Jiang B, et al. Pipeline embolization for salvage treatment of previously stented residual and recurrent cerebral aneurysms. Interv Neurol. 2018;7(6):359–69.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Heiferman DM, Billingsley JT, Kasliwal MK, et al. Use of flow-diverting stents as salvage treatment following failed stent-assisted embolization of intracranial aneurysms. J Neurointerv Surg. 2016;8(7):692–5.

    Article  PubMed  Google Scholar 

  38. Park KY, Yeon JY, Kim BM, et al. Efficacy and safety of flow-diverter therapy for recurrent aneurysms after stent-assisted coiling. AJNR Am J Neuroradiol. 2020;41(4):663–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Gentric JC, Fahed R, Darsaut TE, Salazkin I, Roy D, Raymond J. Fatal arterial rupture during angioplasty of a flow diverter in a recurrent, previously Y-stented giant MCA bifurcation aneurysm. Interv Neuroradiol. 2016;22(3):278–86.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Joshi MD, O'Kelly CJ, Krings T, Fiorella D, Marotta TR. Observer variability of an angiographic grading scale used for the assessment of intracranial aneurysms treated with flow-diverting stents. AJNR Am J Neuroradiol. 2013;34(8):1589–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Goertz L, Hesse N. Liebig T, et al. Neuroradiology: Retreatment strategies for recurrent and residual aneurysms after treatment with flow-diverter devices; 2020.

    Google Scholar 

  42. Kallmes DF, Brinjikji W, Cekirge S, et al. Safety and efficacy of the pipeline embolization device for treatment of intracranial aneurysms: a pooled analysis of 3 large studies. J Neurosurg. 2017;127(4):775–80.

    Article  PubMed  Google Scholar 

  43. Trivelato FP, Ulhoa AC, Rezende MT, Castro-Afonso LH, Abud DG. Recurrence of a totally occluded aneurysm after treatment with a pipeline embolization device. BMJ Case Rep. 2018;2018

    Google Scholar 

  44. Zhang X, Lv N, Wang C, Cao W, Liu J, Huang Q. Late recurrence of a completely occluded large intracranial aneurysm treated with a Tubridge flow diverter. J Neurointerv Surg. 2017;9(2):e6.

    Article  PubMed  Google Scholar 

  45. Nakae R, Takigawa T, Hirata K, Nagaishi M, Hyodo A, Suzuki K. Delayed posttreatment residual flow into aneurysm after flow diverter placement. World Neurosurg. 2018;116:205–8.

    Article  PubMed  Google Scholar 

  46. O'Kelly CJ, Spears J, Chow M, et al. Canadian experience with the pipeline embolization device for repair of unruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2013;34(2):381–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Rouchaud A, Brinjikji W, Lanzino G, Cloft HJ, Kadirvel R, Kallmes DF. Delayed hemorrhagic complications after flow diversion for intracranial aneurysms: a literature overview. Neuroradiology. 2016;58(2):171–7.

    Article  PubMed  Google Scholar 

  48. Roy AK, Grossberg JA, Osbun JW, et al. Carotid cavernous fistula after pipeline placement: a single-center experience and review of the literature. J Neurointerv Surg. 2017;9(2):152–8.

    Article  PubMed  Google Scholar 

  49. Zhou G, Su M, Yin YL, Li MH. Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis. Neurosurg Focus. 2017;42(6):E17.

    Article  PubMed  Google Scholar 

  50. Kallmes DF, Hanel R, Lopes D, et al. International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study. AJNR Am J Neuroradiol. 2015;36(1):108–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Kulcsar Z, Houdart E, Bonafe A, et al. Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol. 2011;32(1):20–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Frosen J, Piippo A, Paetau A, et al. Remodeling of saccular cerebral artery aneurysm wall is associated with rupture: histological analysis of 24 unruptured and 42 ruptured cases. Stroke. 2004;35(10):2287–93.

    Article  PubMed  Google Scholar 

  53. Shapiro M, Becske T, Nelson PK. Learning from failure: persistence of aneurysms following pipeline embolization. J Neurosurg. 2017;126(2):578–85.

    Article  PubMed  Google Scholar 

  54. Kan P, Duckworth E, Puri A, Velat G, Wakhloo A. Treatment failure of fetal posterior communicating artery aneurysms with the pipeline embolization device. J Neurointerv Surg. 2016;8(9):945–8.

    Article  PubMed  Google Scholar 

  55. Daou B, Atallah E, Chalouhi N, et al. Aneurysms with persistent filling after failed treatment with the pipeline embolization device. J Neurosurg. 2018:1–7.

    Google Scholar 

  56. Goertz L, Hesse N, Liebig T, et al. Retreatment strategies for recurrent and residual aneurysms after treatment with flow-diverter devices. Neuroradiology. 2020;62(8):1019–28.

    Article  PubMed  Google Scholar 

  57. Petr O, Petrova L, Bradac O, Glodny B, Edlinger M, Thome C. Safety and efficacy of endovascular treatment of previously clipped aneurysms: a systematic review and meta-analysis. World Neurosurg. 2018;114:e137–50.

    Article  PubMed  Google Scholar 

  58. Thines L, Dehdashti AR, Howard P, et al. Postoperative assessment of clipped aneurysms with 64-slice computerized tomography angiography. Neurosurgery. 2010;67(3):844–53. discussion 853-844

    Article  PubMed  Google Scholar 

  59. Thornton J, Bashir Q, Aletich VA, Debrun GM, Ausman JI, Charbel FT. What percentage of surgically clipped intracranial aneurysms have residual necks? Neurosurgery. 2000;46(6):1294–8. discussion 1298-1300

    Article  CAS  PubMed  Google Scholar 

  60. David CA, Vishteh AG, Spetzler RF, Lemole M, Lawton MT, Partovi S. Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg. 1999;91(3):396–401.

    Article  CAS  PubMed  Google Scholar 

  61. Kivelev J, Tanikawa R, Noda K, et al. Open surgery for recurrent intracranial aneurysms: techniques and long-term outcomes. World Neurosurg. 2016;96:1–9.

    Article  PubMed  Google Scholar 

  62. Sindou M, Acevedo JC, Turjman F. Aneurysmal remnants after microsurgical clipping: classification and results from a prospective angiographic study (in a consecutive series of 305 operated intracranial aneurysms). Acta Neurochir. 1998;140(11):1153–9.

    Article  CAS  PubMed  Google Scholar 

  63. Lin T, Fox AJ, Drake CG. Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg. 1989;70(4):556–60.

    Article  CAS  PubMed  Google Scholar 

  64. Jabbarli R, Pierscianek D, Wrede K, et al. Aneurysm remnant after clipping: the risks and consequences. J Neurosurg. 2016;125(5):1249–55.

    Article  PubMed  Google Scholar 

  65. Kim JH, Chung J, Huh SK, et al. Therapeutic strategies for residual or recurrent intracranial aneurysms after microsurgical clipping. Clin Neurol Neurosurg. 2018;173:110–4.

    Article  PubMed  Google Scholar 

  66. Romagna A, Ladisich B, Schwartz C, Winkler PA, Rahman AA. Flow-diverter stents in the endovascular treatment of remnants in previously clipped ruptured aneurysms: a feasibility study. Interv Neuroradiol. 2019;25(2):144–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Affiliated Hospital of Guiyang Medical University, Guiyang, Guizhou, China

    Zeguang Ren

Authors
  1. Zeguang Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

Case Presentation

Case Presentation

Case 13.1 Recurrent Previously Coiled Ruptured PICA Aneurysm Treated with Recoiling

Case Pearls

  1. 1.

    Recoiling is the first option for narrowed-neck recurrent aneurysm.

  2. 2.

    Good neck framing without blocking the takeoff of the branch can possibly be obtained by re-deploying and adjusting the framing coil.

  3. 3.

    The tip of the microcatheter at the entrance of the neck for the last filing is practical if the microcatheter is kicked back.

  4. 4.

    Neck residual is a risk factor for recurrence.

figure a

(a): Presenting head CT showing SAH (WFNS grade 4, GCS 10); (b): 3D angiogram showing a 5x3 mm left PICA aneurysm with aspect ratio >2; (c): 2D embolization view; (d): post-embo run with slight neck residual; (e and j): recurrence (combination of neck regrowth and coil compaction) on 7-month follow-up angiogram, given the previous rupture history, retreatment planned; (f–i and k–n): 2 embo working views for recoiling, first coil (Target XL coil 3x6) (f, k) with protrusion into lumen, changed to a smaller coil (Target EL 2x6) with good neck coverage with open takeoff of PICA (g, l). Add additional coil (Target Nano 1x3) (h, m), the tip of microcatheter at the entrance of the neck for the last filing coil (arrow). Final run showing RR grade I occlusion (i, n); (o): 8 months from recoiling follow-up showing no residual/recurrence

Case 13.2 Recurrent Previously Coiled BA Aneurysm Treated with SAC with Go Through Technique

Case Pearls

  1. 1.

    SAC may increase the packing density and lower the chance of recurrence.

  2. 2.

    Normally one stent instead of “Y” stent will be enough for BA tip aneurysm.

  3. 3.

    “Going through” SAC technique is more likely successful at BA tip aneurysm than side wall branching point aneurysms.

figure b

(a): 3D angiogram for referred recurrent wide-neck BA tip aneurysm from previous primary coiling; (b): pre-embo 2D working view for the best view of the neck; (c, d): single stent placed from the left PCA to BA given more left PCA involvement of the neck. Stent (yellow dot line) makes “wide” to “narrow” neck (red line); (e, f): coiling catheter goes through stent interstices with good framing; (g, h): additional filling coils to finish the embolization; (i): final run post-coiling. (j): 6-month follow-up angiogram

Case 13.3 Recurrent Previously Coiled BA Aneurysm Treated with “Y” Stent

Case Pearls

  1. 1.

    “Y” stent is normally not needed for the native aneurysm, given one stent can reformat the aneurysm from wide neck to narrow neck.

  2. 2.

    Recurrence from previously stent-assisted coiling can have further neck incorporation of branching vessel to become wide neck again; “Y” stent may be needed.

  3. 3.

    BA tip aneurysm is one of the aneurysm locations with a high chance of recurrence with either primary coiling or SAC.

figure c

(a): 3D angiogram for referred recurrent wide-neck previously SAC BA tip aneurysm (no previous post-embo images available for comparison); (b, c): pre-embo 2D views for the best view of the neck and relationship with parent vessels, inserts: un-subtracted images and single shot for stent contour; (d, e): one stent placed from the left PCA to BA through previously placed stent, and framing coil placement, inserts: single shot for stent contour; (f, g): final run post-coiling. (h): 6-month follow-up angiogram with minimal neck residual; (i): 18-month MRA follow-up showing more neck residual; (j): 26-month follow-up, increased neck residual

Case 13.4 FD Stent for Recurrent/Residual Aneurysms

Case Pearls

  1. 1.

    FD device is a good choice for recurrent previously coiled paraclinoid ICA aneurysms. FD for recurrent previously SAC cases was also reported.

  2. 2.

    FD has a high chance of complete obliteration of non-fetal-type PComA aneurysms.

  3. 3.

    FD can be the second stage of the treatment strategy for the residual of ruptured wide-neck aneurysm (simple coiling first to secure the dome and then definitive FD or SAC treatment when recovered from SAH).

figure d

(a): 3D angiogram of a patient with previous coiling of ruptured PComA aneurysm showing a large recurrence with irregular shape and wide neck; (b): posterior circulation run showing both PCA exist and the PComA is not fetal type; (c, d): pre-embo 2D views for the best view of the neck of aneurysm and distal and proximal landing zone of FD device; (e, f): post-PED (4.25x16 and 4.25x12) angiogram; (g, h): 8-month follow-up angiogram with complete obliteration of recurrence and patent PED; (i–k): comparison of PComA change between pre-embo (i), immediate PED (j), and follow-up (k) angiograms

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ren, Z. (2022). Recurrent/Residual Aneurysms. In: Eight Aneurysms. Springer, Cham. https://doi.org/10.1007/978-3-030-97216-5_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-97216-5_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-97215-8

  • Online ISBN: 978-3-030-97216-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation