Microsurgical Treatment of Previously Coiled Intracranial Aneurysms: Systematic Review of the Literature

Arnaout, Omar; Ahmadieh, Tarek Y. El; Zammar, Samer G.; Tecle, Najib E. El; Hamade, Youssef J.; Aoun, Rami James N.; Aoun, Salah G.; Rahme, Rudy J.; Eddleman, Christopher S.; Barrow, Daniel L.; Batjer, H. Hunt; Bendok, Bernard R.

doi:10.1016/j.wneu.2015.02.027

Cited by 27 publications

(31 citation statements)

References 55 publications

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“…27 Other smaller studies reported occlusion rates ranging from 83% to 100%. 1 Veznedaroglu et al reported that the presence of coils in the aneurysm dome and/or neck makes clipping and exposure of the aneurysm neck difficult, leading to an increased risk of incomplete obliteration (3 of 18 patients in their study).…”

Section: 21mentioning

confidence: 87%

“…The feasibility of this procedure depends on several factors, including the time interval between the coiling procedure and microsurgical clipping, the position of the coils within the aneurysm, and the space available at the base of the aneurysm for clip placement. 1,21,27 Technical difficulties attributed to the coils present in the aneurysmal sac and neck are frequently encountered, making it difficult to properly clip the aneurysm and sometimes requiring removal of such coils. 9,11,25 The removal of coils for clip placement carries high morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…The literature on clipping of previously coiled intracranial aneurysms is still limited, with few institutions reporting their initial experiences. 1,15,21,27 With the growing population of patients harboring recurrent aneurysms, the need for retreatment is growing. More studies are required to evaluate the strategies that should be implemented in the management of recurrent aneurysms.…”

mentioning

confidence: 99%

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Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients

Daou

Chalouhi

Starke

et al. 2016

JNS

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OBJECTIVE With the increasing number of aneurysms treated with endovascular coiling, more recurrences are being encountered. The aim of this study was to evaluate the efficacy and safety of microsurgical clipping in the treatment of recurrent, previously coiled cerebral aneurysms and to identify risk factors that can affect the outcomes of this procedure. METHODS One hundred eleven patients with recurrent aneurysms whose lesions were managed by surgical clipping between January 2002 and October 2014 were identified. The rates of aneurysm occlusion, retreatment, complications, and good clinical outcome were retrospectively determined. Univariate and multivariate logistic regressions were performed to identify factors associated with these outcomes. RESULTS The mean patient age was 50.5 years, the mean aneurysm size was 7 mm, and 97.3% of aneurysms were located in the anterior circulation. The mean follow-up was 22 months. Complete aneurysm occlusion, as assessed by intraoperative angiography, was achieved in 97.3% of aneurysms (108 of 111 patients). Among patients, 1.8% (2 of 111 patients) had a recurrence after clipping. Retreatment was required in 4.5% of patients (5 of 111) after clipping. Major complications were observed in 8% of patients and mortality in 2.7%. Ninety percent of patients had a good clinical outcome. Aneurysm size (OR 1.4, 95% CI 1.08–1.7; p = 0.009) and location in the posterior circulation were significantly associated with higher complications. All 3 patients who had coil extraction experienced a postoperative stroke. Aneurysm size (OR 1.2, 95% CI 1.02–1.45; p = 0.025) and higher number of interventions prior to clipping (OR 5.3, 95% CI 1.3–21.4; p = 0.019) were significant predictors of poor outcome. An aneurysm size > 7 mm was a significant predictor of incomplete obliteration and retreatment (p = 0.018). CONCLUSIONS Surgical clipping is safe and effective in treating recurrent, previously coiled cerebral aneurysms. Aneurysm size, location, and number of previous coiling procedures are important factors to consider in the management of these aneurysms.

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Section: 21mentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients

Daou

Chalouhi

Starke

et al. 2016

JNS

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“…Microsurgical rescue of failed endovascular treatment of cerebral aneurysms is not uncommon; a recent meta-analysis listed 29 reports with a total of 375 microsurgical clippings for previously coiled aneurysms over the past 23 years [2]. Almost all of these rescue operations (>90 %) were for either partially occluded or recurrent aneurysm formation [2].…”

Section: Introductionmentioning

confidence: 99%

“…Almost all of these rescue operations (>90 %) were for either partially occluded or recurrent aneurysm formation [2]. To the best of our knowledge, successful microsurgical rescue treatment with PED removal has never been reported.…”

Section: Introductionmentioning

confidence: 99%

Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm

et al. 2015

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We report the microsurgical rescue and removal of a Pipeline stent embolization of a giant internal carotid artery terminus aneurysm. After the initial placement of a Pipeline Embolization Device (PED), it migrated proximally to the cavernous carotid with the distal end free in the middle of the aneurysm, resulting in only partial aneurysm neck coverage. The patient underwent microsurgical rescue with trapping, bypass, and opening of the aneurysm with PED removal. The vessel remained patent in the proximal segment previously covered by the Pipeline stent. Microsurgical rescue for definitive aneurysm treatment with PED removal can be safe and effective for aneurysms unsuccessfully treated with PED.

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Open Treatment of Cerebral Aneurysms in the Endovascular Age

Jabre

McElenney

Nakaji

2022

Endovascular Surgery of Cerebral Aneurysms

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Microsurgical Treatment of Previously Coiled Intracranial Aneurysms: Systematic Review of the Literature

Cited by 27 publications

References 55 publications

Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients

Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients

Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm

Open Treatment of Cerebral Aneurysms in the Endovascular Age

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