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Abstract - Case Report

J Cerebrovasc Endovasc Neurosurg. 2021 23(2): 117-122
The Journal of Cerebrovascular and Endovascular Neurosurgery
      
 
Rescue endovascular treatment for rapid regrowth of aneurysm remnant on middle cerebral artery trunk after unsuccessful surgical clipping in patients with a ruptured cerebral aneurysm: A report of two cases
Donghwan Jang
Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea

We report two rare cases treated with coiling after rapid regrowth (within a month) of an aneurysm remnant on the middle cerebral artery (MCA) trunk after incomplete surgical clipping. The first case, a 47-year-old man with subarachonoid hemorrhage (SAH) (Hunt-Hess grade II, Fisher grade III) underwent clipping of a ruptured saccular aneurysm with a wide neck on the right early frontal branch arising from the MCA trunk. Incomplete clipping with a 1 mm sized remnant neck was performed to avoid sacrificing the lenticulostriate artery. In a follow-up cerebral angiogram on postoperative day 30, a rapid regrowth of the aneurysm remnant was observed, and on that day, complete obliteration was obtained by rescue endovascular treatment. The second case, a 48-year-old healthy woman with SAH (Hunt-Hess grade II, Fisher grade III) underwent clipping of an anteroposteriorly projecting bilobulated aneurysm on the left M1. Incomplete clipping with a minimal remnant neck was performed. In follow-up digital subtraction angiogram on postoperative day 30, a rapid regrowth of an aneurysm remnant involving only a part of the initial aneurysm near the neck was observed, and on that day, complete obliteration was obtained by rescue coiling. These patients were both discharged without any neurological deficits. Keywords‌Rescue endovascular treatment, Regrowth of aneurysm remnant, Middle cerebral artery trunk, Incomplete surgical clipping
 
Key words : Rescue endovascular treatment, Regrowth of aneurysm remnant, Middle cerebral artery trunk, Incomplete surgical clipping
 
 
    
 
 
 

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