Effect of endovascular coil embolization for recurrent cerebral aneurysms following surgical clipping

A Case of Coil Embolization with Crossing Y-Configuration Stenting for a Recurrent IC-PC Aneurysm after Clipping

“…Treatment by repeat craniotomy for recurrent aneurysms after clipping is often difficult due to the presence of adhesion and clips around the aneurysm, 3,4) and Drake et al reported that intraoperative rupture was likely to occur in patients who receive repeat craniotomy after clipping, that the rate of serious complications was 7.0%, and that the mortality rate was 5.2%. 11) If coil embolization is selected for re-treatment after clipping, there are also reports describing aneurysm neck formation due to the clip and noting that complete occlusion is frequently achieved due to the formation of a narrow neck.…”

“… 1 – 3) Regarding the recurrence of aneurysms after clipping, David et al evaluated 160 aneurysms in 102 patients and reported that recurrence was observed in two (1.5%) of 147 lesions (91.8%) that were completely occluded, with an annual recurrence rate of 0.52%.10) In addition, among eight aneurysms that exhibited dog-ear remnants, one increased in size, one ruptured, and the annual bleeding rate was 1.9% when there were residual aneurysms. Treatment by repeat craniotomy for recurrent aneurysms after clipping is often difficult due to the presence of adhesion and clips around the aneurysm, 3 , 4) and Drake et al reported that intraoperative rupture was likely to occur in patients who receive repeat craniotomy after clipping, that the rate of serious complications was 7.0%, and that the mortality rate was 5.2%. 11) If coil embolization is selected for re-treatment after clipping, there are also reports describing aneurysm neck formation due to the clip and noting that complete occlusion is frequently achieved due to the formation of a narrow neck.…”

“…Although the 10-year incidence of recurrence of intracranial aneurysms at the same site after clipping is <1%, regardless of rupture, 1 , 2) additional treatment for recurrent aneurysms is often difficult. 3 , 4) The therapeutic strategy, including open surgical and endovascular repair, must be evaluated for each patient. Y-configuration stenting (Y-stent-assisted coiling [Y-SAC]) 5) using two stents is an adjunctive technique for coil embolization, and there have been many reports on the application of this technique to basilar tip aneurysms, anterior communicating artery (Acom) aneurysms, and middle cerebral artery (MCA) aneurysms.…”