Clinical presentation and outcomes of coil embolization of remnant or recurred intracranial aneurysm after clipping.

Abstract

OBJECTIVE:

To evaluate clinical presentation, safety, techniques, clinical and angiographic outcomes, and prognostic factors of coiling for remnant/recurred aneurysm after clipping.

METHODS:

Twenty-four consecutive patients (11 men and 13 women; mean age, 52 years) with 24 recurred/remnant aneurysms after clipping underwent coil embolization between September 2000 and December 2008. Clinical presentations of remnant/recurred aneurysms, safety, techniques, clinical and angiographic outcomes, and prognostic factors of coil embolization were retrospectively evaluated.

RESULTS:

Twenty-two aneurysms initially presented with subarachnoid hemorrhage and the other two, with mass effect. Eight aneurysms presented with rebleeding and 16 aneurysms were found on follow-up CT angiogram (n = 12) or catheter angiogram (n = 4). The interval between clipping and coiling ranged from 8 days to 114 months (mean, 31 months). Twelve were treated by using single-catheter, 6 by stent-assisted, 4 by multicatheter, 1 by both balloon- and catheter-assisted, and 1 by balloon-in-stent technique. Immediate postembolization angiogram revealed complete obliteration (n = 19) or residual neck (n = 5). Procedure-related permanent morbidity and mortality rates were 4.2% (1 of 24) and 0%, respectively. There was no rebleeding during clinical follow-up for 3 to 82 months (mean, 24 months). Presentation with rupture after clipping was the only significant predictor of poor outcome (P < .05).

CONCLUSION:

Coiling seems to be a safe and effective retreatment option for remnant/ recurred aneurysm after clipping. Presentation with rupture after clipping is the only predictor of poor outcome. For routine/regular follow-up after clipping, CT angiography may be the imaging modality advisable for detection of remnant/recurred aneurysm.

• Authors: Byung Moon Kim, Dong Joon Kim, Dong Ik Kim, Sung Il Park, Sang Hyun Suh, Yu Sam Won
• Journal: Neurosurgery (Neurosurgery) Vol. 66 Issue 6 Pg. 1128-33; discussion 1133 (Jun 2010) ISSN: 1524-4040 [Electronic] United States
• PMID: 20495427 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Catheters (standards, trends)
• Cerebral Arteries (diagnostic imaging, pathology, surgery)
• Embolization, Therapeutic (instrumentation, methods)
• Female
• Humans
• Intracranial Aneurysm (diagnosis, diagnostic imaging, surgery)
• Male
• Middle Aged
• Outcome Assessment, Health Care (methods)
• Prostheses and Implants
• Radiography
• Reoperation (instrumentation, trends)
• Secondary Prevention
• Stents (standards, trends)
• Subarachnoid Hemorrhage (diagnostic imaging, pathology, surgery)
• Vascular Surgical Procedures (instrumentation, methods)