Surgical Treatment of Recurrent Previously Coiled and/or Stent-Coiled Intracerebral Aneurysms: A Single-Center Experience in a Series of 75 Patients.

Abstract

BACKGROUND\nEndovascular treated cerebral aneurysms have a greater recurrence rate compared with 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.\n\n\nOBJECTIVE\nTo analyze the surgical and radiologic outcome after clipping of previous endovascular treated recurrent cerebral aneurysms.\n\n\nMETHODS\nPatients were retrospectively identified. Demographic data, aneurysm size, location, perioperative coil extraction, occlusion rate, and complication rate were recorded. Patients were divided into a previously coiled-only group (COG) and a previously stent-assisted coiled group (SAC).\n\n\nRESULTS\nSeventy-five patients with 76 aneurysms were included. Sixty-nine patients were included in the COG, 7\xa0patients in the SAC group. Complete or acceptable near-complete occlusion was obtained in 95% of patients in the COG and 57% in the SAC group. Two patients in the COG (2.9%) died postoperatively of a major stroke. One patient died of rehemorrhage after wrapping of an aneurysm. Minor complications occurred in 8.7%. In the SAC group, the mortality was 0%, with 1 major stroke (14.2%), 1 minor stroke (14.2%), and 1 cranial nerve palsy (14.2%). Intraoperative coil extraction and previous stent-assisted coiling were significant predictors of complication rate (P\xa0= 0.025 and P\xa0= 0.0036 respectively). Previous stent-assisted coiling was a significant predictor of incomplete occlusion (P\xa0= 0.036).\n\n\nCONCLUSIONS\nMicrosurgical 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.