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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(04): 1151-1156
DOI: 10.4103/ajns.AJNS_105_19
Original Article

Management of recurrent aneurysms after endovascular coiling: A Fujita experience

Raja Kutty
0   Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala
,
Ambuj Kumar
1   Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh
,
Yasuhiro Yamada
2   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Riki Tanaka
2   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Satish Kannan
3   Department of Neurosurgery, MGM Hospital, Chennai, Tamil Nadu
,
Vigneshwar Ravisankar
3   Department of Neurosurgery, MGM Hospital, Chennai, Tamil Nadu
,
Aaron Musara
4   Department of Neurosurgery, College of Health Sciences, Harare
,
Kyosuke Miyatani
2   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Saeko Higashiguchi
2   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Katsumi Takizawa
5   Department of Neurosurgery, Asahikawa Redcross Hospital, Hokkaido
,
Tsukasa Kawase
2   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
,
Yoko Kato
2   Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya
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Introduction: Microsurgical clipping and Endovascular coiling (EC) are both effective alternatives in the management of intracranial aneurysms. EC has been shown to be associated with the risk of recurrent aneurysm (RA) growth. Considering the minimally invasive nature of this procedure, the management of intracranial aneurysms has been skewed toward EC, especially in the developed world. In this scenario, there has been an upsurge of RAs after EC. Since the optimal management of these RAs has not been defined, they pose a unique challenge to the treating surgeons. Aims and Objectives: The aim of this study is to elucidate the optimal management of RAs after EC. Materials and Methods: Medical records of all patients who underwent surgery for RAs were reviewed from the period January 2014 to March 2019. The demographic and angiographic patterns of the patients and operative techniques and complications were studied. The outcome was dichotomized into good and bad depending on the Glasgow outcome scale (GOS). Results: There were four cases of RAs operated in our institution between the above-mentioned period. There were varied differences between the initial coiling and time to recurrences. All four patients were operated under neuromonitoring. Three underwent clipping and one patient underwent clipping with bypass. All four patients had good outcome with a GOS of 5/5. Conclusion: Operations for RAs constitute many technical challenges and require a lot of expertise. Such surgeries are recommended in high-volume centers, with sufficient experience in both clipping and cerebral bypass.

Key-words:

Aneurysms - endovascular coiling - management - recurrence

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Chen KS, Wilson TJ, Stetler WR, Davis MC, Giles DA, Kahn EN, et al. Management of recurrent aneurysms following endovascular therapy. J Clin Neurosci 2015;22:1901-6.
  • 2 Molyneux AJ, Kerr RS, Birks J, Ramzi N, Yarnold J, Sneade M, et al. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the international subarachnoid aneurysm trial (ISAT): Long-term follow-up. Lancet Neurol 2009;8:427-33.
  • 3 Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005;366:809-17.
  • 4 Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: The cerebral aneurysm rerupture after treatment (CARAT) study. Stroke 2008;39:120-5.
  • 5 Ferns SP, Sprengers ME, van Rooij WJ, Rinkel GJ, van Rijn JC, Bipat S, et al. Coiling of intracranial aneurysms: A systematic review on initial occlusion and reopening and retreatment rates. Stroke 2009;40:e523-9.
  • 6 Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Russin JJ, et al. The barrow ruptured aneurysm trial: 6-year results. J Neurosurg 2015;123:609-17.
  • 7 Ogilvy CS, Chua MH, Fusco MR, Reddy AS, Thomas AJ. Stratification of recanalization for patients with endovascular treatment of intracranial aneurysms. Neurosurgery 2015;76:390-5.
  • 8 Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Nakaji P, et al. Ten-year analysis of saccular aneurysms in the barrow ruptured aneurysm trial. J Neurosurg 2019:1-6. doi: 10.3171/2016.9.
  • 9 Arnaout OM, El Ahmadieh TY, Zammar SG, El Tecle NE, Hamade YJ, Aoun RJ, et al. Microsurgical treatment of previously coiled intracranial aneurysms: Systematic review of the literature. World Neurosurg 2015;84:246-53.
  • 10 Grunwald IQ, Papanagiotou P, Struffert T, Politi M, Krick C, Gül G, et al. Recanalization after endovascular treatment of intracerebral aneurysms. Neuroradiology 2007;49:41-7.
  • 11 Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke 2001;32:1998-2004.
  • 12 Mascitelli JR, Moyle H, Oermann EK, Polykarpou MF, Patel AA, Doshi AH, et al. An update to the raymond-roy occlusion classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg 2015;7:496-502.
  • 13 Kobayashi S, Moroi J, Hikichi K, Yoshioka S, Saito H, Tanabe J, et al. Treatment of recurrent intracranial aneurysms after neck clipping: Novel classification scheme and management strategies. Oper Neurosurg (Hagerstown) 2017;13:670-8.
  • 14 Kang HS, Han MH, Kwon BJ, Kwon OK, Kim SH. Repeat endovascular treatment in post-embolization recurrent intracranial aneurysms. Neurosurgery 2006;58:60-70.
  • 15 Mai JC, Hoh BL. Endovascular management of recurrent aneurysms. Neurol Res 2014;36:323-31.
  • 16 Lee J, Lim JW, Cho YD. Follow-up outcomes after re-embolization for recanalized aneurysms after initial coiling: Further recurrence rates and related risk factors. World Neurosurg 2018;114:e508-17.
  • 17 Dornbos D 3rd, Karras CL, Wenger N, Priddy B, Youssef P, Nimjee SM, et al. Pipeline embolization device for recurrence of previously treated aneurysms. Neurosurg Focus 2017;42:E8.
  • 18 Hong Y, Wang YJ, Deng Z, Wu Q, Zhang JM. Stent-assisted coiling versus coiling in treatment of intracranial aneurysm: A systematic review and meta-analysis. PLoS One 2014;9:e82311.
  • 19 Tähtinen OI, Manninen HI, Vanninen RL, Rautio R, Haapanen A, Seppänen J, et al. Stent-assisted embolization of recurrent or residual intracranial aneurysms. Neuroradiology 2013;55:1221-31.
  • 20 Liu JJ, Nielsen TH, Abhinav K, Lee J, Han SS, Marks MP, et al. Surgical treatment of recurrent previously coiled and/or stent-coiled intracerebral aneurysms: A single-center experience in a series of 75 patients. World Neurosurg 2019. pii: S1878-8750(19)30041-5.
  • 21 Tumialán LM, Zhang YJ, Cawley CM, Dion JE, Tong FC, Barrow DL. Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms: A cautionary report. J Neurosurg 2008;108:1122-9.
  • 22 Toyota S, Kumagai T, Goto T, Mori K, Taki T. Trends in the management of cerebrovascular diseases. Acta Neurochir Suppl 2018;129:53-9.
  • 23 Waldron JS, Halbach VV, Lawton MT. Microsurgical management of incompletely coiled and recurrent aneurysms. Oper Neurosurg 2009;64:301-17.
  • 24 Gurian JH, Martin NA, King WA, Duckwiler GR, Guglielmi G, Viñuela F. Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 1995;83:843-53.
  • 25 Zhang YJ, Barrow DL, Cawley CM, Dion JE. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy. Neurosurgery 2003;52:283-95.
  • 26 Yu LB, Fang ZJ, Yang XJ, Zhang D. Management of residual and recurrent aneurysms after clipping or coiling: Clinical characteristics, treatments, and follow-up outcomes. World Neurosurg 2019;122:e838-46.
  • 27 Shtaya A, Dasgupta D, Millar J, Sparrow O, Bulters D, Duffill J. Outcomes of microsurgical clipping of recurrent aneurysms after endovascular coiling. World Neurosurg 2018;112:e540-7.
  • 28 Nisson PL, Meybodi AT, Roussas A, James W, Berger GK, Benet A et.al., Surgical Clipping of Previously Ruptured, Coiled Aneurysms: Outcome Assessment in 53 Patients. World Neurosurg. 2018 Dec;120:e203-e211. doi: 10.1016/j.wneu.2018.07.293.
  • 29 Wang HW, Sun ZH, Wu C, Xue Z, Yu XG. Surgical management of recurrent aneurysms after coiling treatment. Br J Neurosurg 2017;31:96-100.
  • 30 Kivelev J, Tanikawa R, Noda K, Hernesniemi J, Niemelä M, Takizawa K, et al. Surgical management of recurrent aneurysms after coiling treatment. World Neurosurg 2016;96:1-9.
  • 31 Daou B, Chalouhi N, Starke RM, Barros G, Ya'qoub L, Do J, et al. Clipping of previously coiled cerebral aneurysms: Efficacy, safety, and predictors in a cohort of 111 patients. J Neurosurg 2016;125:1337-43.
  • 32 Owen CM, Montemurro N, Lawton MT. Microsurgical management of residual and recurrent aneurysms after coiling and clipping: An experience with 97 patients. Neurosurgery 2015;62 Suppl 1:92-102.
  • 33 Izumo T, Matsuo T, Morofuji Y, Hiu T, Horie N, Hayashi K, et al. Microsurgical clipping for recurrent aneurysms after initial endovascular coil embolization. World Neurosurg 2015;83:211-8.