Retreatment of Previously Embolized Cerebral Aneurysms: The Risk of Further Coil Embolization Does Not Negate the Advantage of the Initial Embolization

Abstract

BACKGROUND AND PURPOSE: A significant minority of aneurysms treated by endovascular means undergo additional subsequent therapy to treat aneurysm recurrence. Our study was undertaken to determine the risk of additional coil embolization of aneurysms recurring following endovascular therapy.

A Prospective Trial of 3T and 1.5T Time-of-Flight and Contrast-Enhanced MR Angiography in the Follow-Up of Coiled Intracranial Aneurysms

“…Smaller remnants are typically not treated, whereas larger remnants may prompt additional therapies, either repeat coiling or surgical clipping. 3,21 When the performance of MRA in detecting these larger and thus clinically more worrisome aneurysm remnants was evaluated, sensitivities diminished; this change is largely explained by MRA misclassification of class 3 aneurysm remnants as class 2. However, CE-MRA at both field strengths had greater sensitivity (ie, less underclassification) for these larger (class 3 or 4) aneurysm remnants than TOF-MRA at 1.5T.…”

Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

“…44 These outcomes are per procedure, and the risk per patient would increase in cases of retreatment, the latter being negligible after clipping. Renowden et al 47 reported that 6% of 1631 patients required retreatment after coiling of 1834 mostly ruptured aneurysms. They found a lower morbidity in retreatment coiling procedures compared with the initial procedure: 3 cases of thromboembolism from 99 recoiling procedures.…”

Complications and Adverse Events Associated with Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms

“…In our series, no adverse events were shown on follow-up angiograms or occurred during retreatment with detachable coils. Recently, Renowden et al 42 and Henkes et al 43 reported complication rates of 2% to 3% in their large series of retreatment of previously embolized aneurysms. Followup procedures can be done safely, and the risk from retreatment with detachable coils does not negate the advantages of initial use of coil embolization.…”