title: Management of residual and recurrent aneurysms after initial endovascular treatment.
abstract: BACKGROUND
  Coil instability possibly translating into higher delayed rebleeding rates remains a concern in the endovascular management of cerebral aneurysms.
  
  
  OBJECTIVE
  To report on 127 patients with endovascular aneurysmal remnants who underwent re-treatment over an 18 year period.
  
  
  METHODS
  Patients presenting with aneurysm residuals >20% of the original lesion, unstable neck remnants, aneurysmal regrowth, or new aneurysmal daughter sacs were treated by an individualized approach, using both endovascular and surgical techniques.
  
  
  RESULTS
  Seventy-five aneurysmal remnants (59.1%) were treated by further re-embolization. Standard coil embolization was used in 65 cases, stent-protected coiling in 9 cases, and balloon remodeled coiling in 1 case, respectively. Fifty-two (40.9%) aneurysmal remnants were treated surgically. Standard microsurgical clipping was used in 44 patients, parent artery occlusion or trapping under bypass protection in 5 cases, deliberate clipping of the basilar artery trunk in 2 cases, and aneurysm wrapping in one case, respectively. Mechanisms of aneurysm recurrence were coil compaction in 93 cases and regrowth in 34 cases. A single reembolization was sufficient to occlude 78.7% of recurrences from coil compaction, but only 14.3% of recurrences from aneurysm regrowth.
  
  
  CONCLUSIONS
  The individualized approach resulted in complete occlusion of 114 aneurysms (89.7%), with neck remnants and residual aneurysms detectable in 11 (8.7%) and 2 (1.6%) cases, respectively. Treatment morbidity was 11.9%, without significant differences between surgical (15.6%) and endovascular (9.3%) patients (P = .09). Recurrences from coil compaction were safely treated by re-embolization, whereas recurrences from aneurysmal regrowth may best be managed surgically when technically feasible.
authors: Medical University of Vienna, Department of Neurosurgery, Waehringer Guertel, Vienna, Austria. christian.dorfer@meduniwien.ac.at
authors: Christian
authors: C
authors: Dorfer
authors: Andreas
authors: A
authors: Gruber
authors: Harald
authors: H
authors: Standhardt
authors: Gerhard
authors: G
authors: Bavinzski
authors: Engelbert
authors: E
authors: Knosp
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D019635:Neurosurgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D012008:Recurrence; D019233:Retreatment / Q000706:statistics & numerical data*; D015607:Stents / Q000706:statistics & numerical data; D013525:Surgical Instruments / Q000706:statistics & numerical data; D055815:Young Adult