Introduction: Endovascular treated cerebral aneurysms has a greater recurrence rate compared to microsurgical clip ligation. Although repeat endovascular treatment is an option, microsurgical clip ligation might still be the treatment of choice for some previously endovascular treated recurrent aneurysms. We report on our single-center experience with 74 previously coiled and or stented aneurysms.
Methods: Patients were retrospectively identified from our institution’s database. Demographic data, aneurysm size, location, perioperative coil extraction, occlusion rate and complication rate was recorded. Patients were divided into a previously coiled-only group and a previously stent-assisted coiled group.
Results: Sixty-seven patients were included in the coil-only group, seven patients in the stent-assisted coil group. 63 (94.0%) patients presented initially with subarachnoid haemorrhage. Angiographic follow-up was available for 51 and 7 patients in each group. Complete or near-complete occlusion with acceptable small residual neck after clipping was obtained in 98.0% of patients in the coil-only group as opposed to 57.1% in the stent-assisted coiling group. In the coil-only group the mortality was 3.0%. One patient (1.5%) died from a major stroke and one patient (1.5%) died from re-hemorrhage 6 days after wrapping of a fragile basilar apex aneurysm. Minor complications (1 minor stroke that resolved, 1 wound infection, 1 hemorrhage not requiring evacuation and 1 cranial nerve palsy) occurred in 4.5%. In the stent-assisted coiling group the mortality was 0%. One major stroke (14.2%), 2 (28.6%) minor strokes that resolved and 1 (14.2%) cranial nerve palsy occurred in this group. Intraoperative coil extraction and previous stent-assisted coiling were significant predictors of complication rate in multivariate analysis (p=0.024 and p=0.004 respectively). Previous stent-assisted coiling was a significant predictor of incomplete occlusion (p=0.036).
Conclusions: Microsurgical clipping of previously endovascular treated recurrent aneurysms is effective and safe. However, previously stent-assisted coiling and intraoperative coil extraction are predictors of worse outcome and incomplete occlusion.
Patient Care: Propose factors that predict worse outcome for clipping of previous endovascular treated outcome
Learning Objectives: Microsurgery for previous endovascular treated aneurysms is overall safe but previous stent-assisted coiling and intraoperative coil extraction are predictors of worse outcome and incomplete occlusion