Microsurgical ligation for incompletely coiled or recurrent intracranial aneurysms: a 17-year single-center experience

Abstract

Background: In this retrospective single-center study, we presented our experience in the microsurgical management of incompletely coiled or recurrent aneurysms after initial endovascular coiling. Methods: During a 17-year period, 48 patients underwent microsurgical clipping of incompletely coiled or recurrent aneurysms after coiling (Gurian group B). The clinical data, surgical technique, and postoperative outcome were recorded and analyzed. Results: Before coiling, 42 patients (87.5%) experienced aneurysm rupture. Most of the aneurysms (46/48, 96%) were located in the anterior circulation. After coiling, 6 patients had incompletely coiled aneurysms and 42 patients had recurrent aneurysms, with a mean time of 20.2 months from coiling to recurrence. Coil extrusion occurred in none of the incompletely coiled aneurysms and 71% (30/42) of the recurrent aneurysms. Clipping techniques are direct microsurgical clipping without coil removal in 16 patients, partial coil removal in 14 patients, and total coil removal in 18 patients. Postoperative and follow-up angiography revealed complete occlusion of the aneurysms in all patients. No patient died during postoperative follow-up period (mean, 78.9 months; range, 10-190 months). Good outcomes (GOS of 4 or 5) were achieved in 87.5% (42/48) of the patients at the final follow-up. Conclusions: Microsurgical clipping is effective for incompletely coiled or recurrent aneurysms after initial coiling. For recurrent aneurysms that have coils in the neck, have no adequate neck for clipping, or cause mass effects on surrounding structures, partial or total removal of coiled mass can facilitate surgical clipping and lead to successful obliteration of the aneurysms.

Disturbed flow's impact on cellular changes indicative of vascular aneurysm initiation, expansion, and rupture: A pathological and methodological review

“…Endovascular insertion of platinum or titanium coils into the aneurysm sac limit also aims to limit aneurysmal flow, causing a 13%-60% reduction in intra-aneurysmal velocity, varying by aneurysm location and coil length/stiffness (Fujimura et al, 2018). In broad-necked saccular aneurysms, neck >4 mm or dome/neck ratio <1.5 (Piotin & Blanc, 2014), coils are often paired with stents to prevent coil dislocation (Nikoubashman et al, 2015;Wu et al, 2019). Although stents limit aneurysm rupture risks, their design and implantation can cause unintended disruptions to flow within a treaded vessel (Ng et al, 2017;J.…”

Surgical Clipping of Previously Coiled Recurrent Intracranial Aneurysms: A Single-Center Experience

“…In contrast, a bypass strategy with parent artery occlusion can be executed methodically for unclippable aneurysms (19,(24)(25)(26)28). Currently, many types of extracranial-to-intracranial bypasses, including high-flow bypasses with saphenous veins or radial artery grafts, have been developed to revascularize the parent artery of unclippable IAs effectively (29).…”