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Chirurgia 2015 August;28(4):149-53


language: English

Endovascular treatment for remnant or recurrence of intracerebral aneurysms after clipping

Nomura M. 1, Tamase A. 1, Kamide T. 1, Mori K. 1, Seki S. 1, Muramatsu N. 2, Shima H. 3

1 Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan; 2 Department of Neurosurgery, Fukui Prefectural Hospital, Yokohama, Japan; 3 Department of Neurosurgery, Shima Neurosurgical Clinic, Yokohama, Japan


AIM: An aneurysm remnant or recurrence has the potential risk of rupture; therefore, additional treatment is recommended. However, repeated clipping surgery might be difficult due to preexisting clips and postoperative tissue adhesion.
METHODS: Between 2004 and 2013, we encountered 4 patients with previously clipped aneurysms which were embolized with platinum coils. Two patients with aneurysms at the internal carotid artery and posterior communicating artery (IC-PCoA) bifurcation showed subarachnoid hemorrhage from the recurring aneurysms: a ruptured aneurysm clipped 20 years ago and an unruptured aneurysm clipped 17 years ago. In the latter patient, the exravasation of contrast medium and coil dislodgement from the aneurysm occurred during the procedure. In the other 2 patients, the residual aneurysms of IC-PCoA and the anterior communicating artery (AComA) aneurysms after clipping were treated within a short postoperative period. One of them suffered from intracerebral hemorrhage in the right frontal lobe adjacent to the clip.
RESULTS: In all patients, the aneurysms were successfully embolized with platinum coils. During the procedures, in 2 patients with IC-PCoA and AComA aneurysms, the working angle had to be changed step by step.
CONCLUSION: Endovascular treatment using platinum coils is an effective technique for patients with residual or recurring aneurysms after clipping. However, preexisting clips may be obstacles to visualizing the aneurysm and parent artery during catheterization and coil filling. In such cases, the working angle should be changed in any step to visualize the aneurysm neck and parent artery.

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