Endovascular management for retreatment of postsurgical intracranial aneurysms

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 pre...

Full description

Saved in:
Bibliographic Details
Published in:Neuroradiology 2013-11, Vol.55 (11), p.1345-1353
Main Authors: Li, Ke, Cho, Young Dae, Kang, Hyun-Seung, Kim, Jeong Eun, Han, Moon Hee, Lee, Yong Man
Format: Article
Language:English
Subjects:
Aneurysms
Cerebral Revascularization - methods
Endovascular Procedures - instrumentation
Endovascular Procedures - methods
Female
Humans
Imaging
Interventional Neuroradiology
Intracranial Aneurysm - diagnostic imaging
Intracranial Aneurysm - surgery
Male
Medical treatment
Medicine
Medicine & Public Health
Middle Aged
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Postoperative Care - methods
Postoperative period
Radiography, Interventional - methods
Radiology
Reoperation - methods
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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.
ISSN:0028-3940
1432-1920
DOI:10.1007/s00234-013-1270-6