The need to pursue long-term follow-up in patients treated for a
ruptured aneurysm remains debated. New
aneurysms development is a crucial
element to consider but remains scarcely analyzed especially after a mean follow-up longer than 10 years. Our study was designed to provide rates of newly developed
aneurysms in patients who have undergone prior clipping who were not followed with serial imaging. Patients were included if they were (1) treated more than 10 years ago by clipping of a
ruptured aneurysm, (2) independent at time of discharge, (3) presently younger than 65 years, and if (4) they agreed to undergo a late digital subtraction angiography (DSA) control or to transmit results of a recent one performed elsewhere. Twenty patients were included with a mean delay between
aneurysm treatment and late DSA of 18.0 years (10-26.5 years). Out of these patients, six (30%) harbored new
aneurysms. Of these six individuals, four (66.6%) presented multiple
aneurysms with a total of 15 newly discovered
aneurysms.
Aneurysm sizes ranged from 1 to 10 mm. One patient suffered from a de novo
aneurysm rupture. Multiple
aneurysms at the time of the first
hemorrhage were a risk factor in developing de novo
aneurysm (p=0.0175). In conclusion, based on a 30% rate of new
aneurysm formation in patients clipped more than a decade ago, close screening on a very long-term perspective is encouraged. This study suggests
aneurysm formation to be a continuous process.