The Journal of Cerebrovascular and Endovascular Neurosurgery

Abstract - Original Article

J Cerebrovasc Endovasc Neurosurg. 2021 23(3): 221-232

Endovascular treatment of residual or recurrent intracranial aneurysms after surgical clipping

Nilton Rocha da Silva Júnior1, Felipe Padovani Trivelato1, Guilherme Seizem Nakiri2, Marco Túlio Salles Rezende1, Luís Henrique de Castro-Afonso2, Thiago Giansante Abud3, José Ricardo Vanzin4, Luciano Bambini Manzato4, Alexandre Cordeiro Ulhôa1, Daniel Giansante Abud2, Alexandre Varella Giannetti5

1Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil 2Division of Interventional Neuroradiology, Hospital das Clínicas, Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil 3Division of Interventional Neuroradiology, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Division of Interventional Neuroradiology, Hospital de Clínicas, Passo Fundo, Rio Grande do Sul, Brazil 5Department of Neurosurgery, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

Objective: Total aneurysm occlusion is crucial for the prevention of rebleeding of a ruptured aneurysm or to avoid rupture of an unruptured lesion. Both surgical and endovascular embolization fail to achieve complete aneurysm occlusion in all the cases. The objective of the study was to establish the safety and efficacy of endovascular treatment for previously clipped residual or recurrent aneurysms. Methods: This was an observational, retrospective study of patients harboring incompletely occluded intracranial aneurysms after clipping who underwent endovascular treatment. Patients were treated using 4 different techniques: (1) simple coiling, (2) balloon remodeling, (3) stent-assisted coiling, and (4) flow diversion. Analyses were performed to identify predictors of total aneurysm occlusion, recanalization and complications. Results: Between May 2010 and September 2018, 70 patients harboring incompletely occluded intracranial aneurysms after clipping met the inclusion criteria in 5 centers. The mean residual aneurysm size was 7.5 mm. Fifty-nine aneurysms were unruptured. Total aneurysm occlusion was achieved in 75.3% of the aneurysms after 1 year. All aneurysms treated with flow diversion revealed complete occlusion according to control angiography. Recanalization was observed in 14.5%. Permanent morbidity and mortality occurred in 2.9% and 1.4% of the patients, respectively. Conclusions: Endovascular treatment of recurrent or residual aneurysms after surgical clipping was safe and efficacious. Flow diversion seems to be associated with better anatomical results. A more rigid study, a larger group of patients, and long-term follow-up are required to provide stronger conclusions about the best approach for residual clipped aneurysms.

Key words : ‌Aneurysm, Clipping, Embolization, Endovascular