Skip to main content
SpringerLink
Log in

Endovascular management for retreatment of postsurgical intracranial aneurysms

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Incomplete surgical treatment of intracranial aneurysms and recurrent postsurgical aneurysms are associated with a risk of rebleeding, and additional treatment is generally recommended. Surgical retreatment may carry a risk of procedural complications due to technical difficulty. We present here our experience with the endovascular approach for the retreatment of intracranial aneurysms that were initially treated with open surgery.

Methods

From January 2002 through January 2013, a total of 43 patients with 43 postsurgical index aneurysms were identified and underwent subsequent endovascular treatment. Clinical and radiological data were retrospectively reviewed.

Results

Thirty-one patients were surgically clipped before endovascular coiling and 12 patients were nonclipped, which included wrapping. Hemorrhagic presentation occurred in 21 patients prior to coiling. The interval between the initial surgical treatment and coiling varied from 0 days to 264 months (median, 9 months). Endovascular coiling resulted in the successful occlusion of 36 aneurysms (84 %). Procedure-related complications included asymptomatic thrombus formation in six patients, symptomatic cerebral infarction in two patients, and retroperitoneal hemorrhage in one patient. Delayed cerebral infarction occurred in two patients with a deployed stent. The procedure-related permanent morbidity and mortality rates were 6.9 and 0 %, respectively. Radiological follow-up evaluations beyond 6 months were available in 26 patients (60 %), which revealed major recanalization in three patients (11.5 %). There was no rebleeding during the follow-up period, which ranged from 3 to 115 months (mean, 34.5 months).

Conclusion

Endovascular embolization may serve as a safe, efficacious, and durable treatment option in the management of postsurgical intracranial aneurysms.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Giannotta SL, Litofsky NS (1995) Reoperative management of intracranial aneurysms. J Neurosurg 83:387–393

    Article  PubMed  CAS  Google Scholar 

  2. Drake CG, Friedman AH, Peerless SJ (1984) Failed aneurysm surgery. Reoperation in 115 cases. J Neurosurg 61:848–856

    Article  PubMed  CAS  Google Scholar 

  3. Proust F, Toussaint P, Hannequin D et al (1997) Outcome in 43 patients with distal anterior cerebral artery aneurysms. Stroke 28:2405–2409

    Article  PubMed  CAS  Google Scholar 

  4. Feuerberg I, Lindquist C, Lindqvist M et al (1987) Natural history of postoperative aneurysm rests. J Neurosurg 66:30–34

    Article  PubMed  CAS  Google Scholar 

  5. Macdonald RL, Wallace MC, Kestle JR (1993) Role of angiography following aneurysm surgery. J Neurosurg 79:826–832

    Article  PubMed  CAS  Google Scholar 

  6. Kang HS, Han MH, Kwon BJ et al (2004) Postoperative 3D angiography in intracranial aneurysms. AJNR Am J Neuroradiol 25:1463–1469

    PubMed  Google Scholar 

  7. Tsutsumi K, Ueki K, Morita A et al (2001) Risk of aneurysm recurrence in patients with clipped cerebral aneurysms: results of long-term follow-up angiography. Stroke 32:1191–1194

    Article  PubMed  CAS  Google Scholar 

  8. Molyneux A, Kerr R, Stratton I et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274

    Article  PubMed  Google Scholar 

  9. Thielen KR, Nichols DA, Fulgham JR et al (1997) Endovascular treatment of cerebral aneurysms following incomplete clipping. J Neurosurg 87:184–189

    Article  PubMed  CAS  Google Scholar 

  10. Pierot L, Boulin A, Visot A et al (1999) Postoperative aneurysm remnants: endovascular treatment as an alternative to further surgery. Neuroradiology 41:315–319

    Article  PubMed  CAS  Google Scholar 

  11. Rabinstein AA, Nichols DA (2003) Endovascular coil embolization of cerebral aneurysm remnants after incomplete surgical obliteration. Stroke 33:1809–1815

    Article  Google Scholar 

  12. Mangiafico S, Cellerini M, Villa G et al (2005) Endovascular coiling of aneurysm remnants after clipping in patients with follow-up. A single center experience. Interv Neuroradiol 11:41–48

    PubMed  CAS  Google Scholar 

  13. Kim BM, Kim DJ, Kim DI et al (2010) Clinical presentation and outcomes of coil embolization of remnant or recurred intracranial aneurysm after clipping. Neurosurgery 66:1128–1133

    Article  PubMed  Google Scholar 

  14. Spiotta AM, Hui F, Schuette A et al (2013) Patterns of aneurysm recurrence after microsurgical clip obliteration. Neurosurgery 72:65–69

    Article  PubMed  Google Scholar 

  15. Cho YD, Lee JY, Seo JH et al (2012) Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms. Eur J Radiol 81:2833–2838

    Article  PubMed  Google Scholar 

  16. Roy D, Milot G, Raymond J (2001) Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004

    Article  PubMed  CAS  Google Scholar 

  17. David CA, Vishteh AG, Spetzler RF et al (1999) Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg 91:396–401

    Article  PubMed  CAS  Google Scholar 

  18. Johnston SC, Dowd CF, Higashida RT et al (2008) Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 39:120–125

    Article  PubMed  Google Scholar 

  19. Ebina K, Suzuki M, Andoh A et al (1982) Recurrence of cerebral aneurysm after initial neck clipping. Neurosurgery 11:764–768

    Article  PubMed  CAS  Google Scholar 

  20. Lin T, Fox AJ, Drake CG (1989) Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:556–560

    Article  PubMed  CAS  Google Scholar 

  21. Hoh BL, Carter BS, Putman CM et al (2003) Important factors for a combined neurovascular team to consider in selecting a treatment modality for patients with previously clipped residual and recurrent intracranial aneurysms. Neurosurgery 52:732–738

    Article  PubMed  Google Scholar 

  22. Todd NV, Tocher JL, Jones PA et al (1989) Outcome following aneurysm wrapping: a 10-year follow-up review of clipped and wrapped aneurysms. J Neurosurg 70:841–846

    Article  PubMed  CAS  Google Scholar 

  23. Fujiwara S, Fujii K, Nishio S et al (1990) Long-term results of wrapping of intracranial ruptured aneurysms. Acta Neurochir (Wien) 103:27–29

    Article  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A111101).

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Interventional Radiology, 1st Affiliated Hospital of Dalian Medical University, Dalian, China

    Ke Li

  2. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehangno, Jongno-gu, Seoul, 110-744, South Korea

    Young Dae Cho & Moon Hee Han

  3. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Hyun-Seung Kang, Jeong Eun Kim & Moon Hee Han

  4. Department of Neurology, Sunlin Hospital, Handong University, Pohang, South Korea

    Yong Man Lee

Authors
  1. Ke Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young Dae Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyun-Seung Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeong Eun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Moon Hee Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong Man Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Young Dae Cho.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, K., Cho, Y.D., Kang, HS. et al. Endovascular management for retreatment of postsurgical intracranial aneurysms. Neuroradiology 55, 1345–1353 (2013). https://doi.org/10.1007/s00234-013-1270-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-013-1270-6

Keywords

Search

Navigation