Coiling of Recurrent and Residual Cerebral Aneurysms after Unsuccessful Clipping

Abstract

We treated four patients with 3 recurrent and 1 residual aneurysm after surgical clipping by using Guglielmi detachable coils (GDCs). Three subjects presented after a second subarachnoid hemorrhage (SAH) occurring between 10 and 25 years after the first bleeding. Early postoperative angiography of the fourth patient showed an incompletely clipped aneurysm. In three poor grade patients we observed one good outcome, one fair result and one death due to the sequelae of SAH. One good grade patient remained in excellent condition postoperatively. Three aneurysms were totally occluded and in one a more than 90% occlusion was achieved with GDCs. We consider the treatment with GDC a viable alternative to reoperation in all patients with recurrent or residual aneurysms following failed attempt at surgical obliteration.

The Merits of Endovascular Coil Surgery for Patients with Unruptured Intracranial Aneurysms

“…Attempts at surgical re-exploration are technically difficult and carry significant risk 1,13) . We treated four of these patients : two recurrent, one residual, and one failed aneurysm treatment after surgical clipping.…”

Usefulness of the Behavior of Fibroblast Attachment to Coils in Thermoreversible Gelation Polymer for Aneurysmal Coil Treatment

“…On the other hand, in large aneurysms, varying amount of old clot in the central aneurysm portions were still detected about 21days after embolization. Organization in large lesions took longer time and seemed to create difficulties for fibroblasts to ingrow [8]. Fibroblasts delivered in aneurysms could promote the organization in aneurismal thrombus [9,10], even if they are in TGP environment [18].…”

“…In some wide-neck or large/giant aneurysms, the thurombus induced by coil placement remains poorly organized after 3 weeks from treatment. In small aneurysms within the first week post-treatment few fibloblasts and non-organized thrombus were present, but during the second week fibroblastic ingrowth was more prominent within the advancing from the periphery granulation [8]. Fibloblasts accelarated early histlogical profliferation/maturation compared to controls [9,10].At the completion of the process, tissues obliterating the aneurysm neck orifice were usually covered by neoendothelial membrane [11], replacing the surface of the initial fresh thrombus [12].…”

Spontaneous Regression of Aneurysm Remnant after Incomplete Surgical Clipping in a Patient with Ruptured Cerebral Aneurysm

“…The risk of regrowth and rupture of a remnant aneurysm warrants close follow-up with digital subtraction angiography (DSA) with additional endovascular coiling or surgical clipping if needed. 1) 5) 6) To the best of my knowledge, cases of spontaneous regression of aneurysm remnant after surgical clipping have rarely been reported. Here in, we report a rare case of aneurysm remnant which regressed without additional treatment during the observation period.…”