title: Clinical presentation and outcomes of coil embolization of remnant or recurred intracranial aneurysm after clipping.
abstract: OBJECTIVE
  To evaluate clinical presentation, safety, techniques, clinical and angiographic outcomes, and prognostic factors of coiling for remnant/recurred aneurysm after clipping.
  
  
  METHODS
  Twenty-four consecutive patients (11 men and 13 women; mean age, 52 years) with 24 recurred/remnant aneurysms after clipping underwent coil embolization between September 2000 and December 2008. Clinical presentations of remnant/recurred aneurysms, safety, techniques, clinical and angiographic outcomes, and prognostic factors of coil embolization were retrospectively evaluated.
  
  
  RESULTS
  Twenty-two aneurysms initially presented with subarachnoid hemorrhage and the other two, with mass effect. Eight aneurysms presented with rebleeding and 16 aneurysms were found on follow-up CT angiogram (n = 12) or catheter angiogram (n = 4). The interval between clipping and coiling ranged from 8 days to 114 months (mean, 31 months). Twelve were treated by using single-catheter, 6 by stent-assisted, 4 by multicatheter, 1 by both balloon- and catheter-assisted, and 1 by balloon-in-stent technique. Immediate postembolization angiogram revealed complete obliteration (n = 19) or residual neck (n = 5). Procedure-related permanent morbidity and mortality rates were 4.2% (1 of 24) and 0%, respectively. There was no rebleeding during clinical follow-up for 3 to 82 months (mean, 24 months). Presentation with rupture after clipping was the only significant predictor of poor outcome (P < .05).
  
  
  CONCLUSIONS
  Coiling seems to be a safe and effective retreatment option for remnant/ recurred aneurysm after clipping. Presentation with rupture after clipping is the only predictor of poor outcome. For routine/regular follow-up after clipping, CT angiography may be the imaging modality advisable for detection of remnant/recurred aneurysm.
authors.affiliation: Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. bmoon21@hanmail.net
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Park
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Suh
authors.forename: Yu Sam
authors.initials: YS
authors.lastname: Won
mesh_terms: D000328:Adult; D000368:Aged; D057785:Catheters / Q000592:standards / Q000639:trends; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D019736:Prostheses and Implants; D011859:Radiography; D012086:Reoperation / Q000295:instrumentation / Q000639:trends; D055502:Secondary Prevention; D015607:Stents / Q000592:standards / Q000639:trends; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods*