Objective: To assess management techniques for residual and recurrent lesions of embolized ruptured intracranial aneurysms, we present a consecutive series of 12 patients who underwent additional treatment using endovascular or surgical techniques.
Methods: We treated 144 patients with ruptured cerebral aneurysms by coil embolization over a period of four years. Follow-up angiography or magnetic resonance angiography was obtained every six months postembolization for 105 patients. Patients presenting with rapid increase of residual and recurrent lesions, those larger than 30% of the original lesion, or those that had blebs underwent additional treatment using both endovascular and surgical techniques. The choice of additional treatment was determined by angiographic findings of framing coils previously embolized and remnant necks.
Results: During the follow-up period, 12 patients underwent additional treatment. Five patients were treated by coil embolization, and seven by surgical clipping. There were no neurological complications in the 12 patients who underwent additional treatment.
Conclusions: Management of residual and recurrent lesions of embolized ruptured cerebral aneurysms requires careful follow-up using neuroimaging modalities, active decisions for additional treatment, and proper choice of treatment using both endovascular and surgical techniques. Under this management, additional treatment can be performed safely.