Surgical Treatment of Recurrent Previously Coiled and/or Stent-Coiled Intracerebral Aneurysms: A Single-Center Experience in a Series of 75 Patients. World neurosurgery Liu, J. J., Nielsen, T. H., Abhinav, K., Lee, J., Han, S. S., Marks, M. P., Do, H. M., Dodd, R. L., Steinberg, G. K. 2019


BACKGROUND: Endovascular treated cerebral aneurysms have a greater recurrence rate compared to microsurgical clip ligation. Despite recent endovascular advances, microsurgical clip ligation might be the treatment of choice for certain previously endovascular treated recurrent aneurysms. We report on our single-center experience with 76 previously coiled and/or stent-coiled aneurysms.OBJECTIVE: To analyse the surgical and radiological outcome after clipping of previous endovascular treated recurrent cerebral aneurysms.METHODS: Patients were retrospectively identified. Demographic data, aneurysm size, location, perioperative coil extraction, occlusion rate and complication rate was recorded. Patients were divided into a previously coiled-only group (COG) and a previously stent-assisted coiled group (SAC).RESULTS: Seventy-five patients with seventy-six aneurysms were included. Sixty-nine patients were included in the COG, seven patients in the SAC. Complete or acceptable near-complete occlusion was obtained in 95% of patients in the COG and 57% in the SAC. Two patients in the COG (2.9%) died postoperatively from a major stroke. One patient died from re-hemorrhage after wrapping of an aneurysm. Minor complications occurred in 8.7%. In the SAC the mortality was 0% with one major stroke (14.2%), 1 (14.2%) minor stroke and 1 (14.2%) cranial nerve palsy. Intraoperative coil extraction and previous stent-assisted coiling were significant predictors of complication rate (p=0.025 and p=0.0036 respectively). Previous stent-assisted coiling was a significant predictor of incomplete occlusion (p=0.036).CONCLUSIONS: Microsurgical clipping of previously endovascular treated recurrent aneurysms is an effective treatment with high obliteration rates. Previously stent-assisted coiling and intraoperative coil extraction are predictors of worse outcome and incomplete occlusion.

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