title: Experience with coil embolization of previously clipped aneurysms presenting with rupture.
abstract: BACKGROUND
  Endovascular coil embolization has an established role alongside microsurgical clipping in the treatment of aneurysms. We studied previously clipped aneurysms that presented as subarachnoid hemorrhage and were treated by coil embolization.
  
  
  METHODS
  A retrospective review was performed of two prospectively maintained databases from two institutions (Cleveland Clinic, Emory University) that spanned 12 years.
  
  
  RESULTS
  Seven patients were identified (mean age 56.9 years) who had previously undergone surgical clipping for aneurysm obliteration; six (86%) were previously ruptured. Patients presented with aneurysm rupture with a mean time of 11.5 years (range 4 months to 20 years) following surgical treatment. Aneurysm location included anterior communicating artery (n=4), posterior communicating artery (n=1), internal carotid artery terminus (n=1) and anterior choroidal (n=1). Three patients presented in Hunt and Hess (HH) grade 1, one in HH2, two in HH3 and one in HH4. Four of the patients underwent unassisted coil embolization while balloon assistance was employed in three. Angiographic results were as follows: complete occlusion (n=3; 42.9%) and residual neck (n=4; 57.1%). There were no intraprocedural complications.
  
  
  CONCLUSIONS
  Aneurysm rupture following surgical obliteration is a rare event and may occur remote from the initial treatment. Endovascular embolization with or without balloon assistance can be safely employed in cases of aneurysm recurrence rupture following surgical treatment with satisfactory angiographic treatment.
authors: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Alejandro M
authors: AM
authors: Spiotta
authors: Albert
authors: A
authors: Schuette
authors: Ferdinand
authors: F
authors: Hui
authors: Rishi
authors: R
authors: Gupta
authors: Charles M
authors: CM
authors: Cawley
authors: Shaye I
authors: SI
authors: Moskowitz
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D016208:Databases, Factual / Q000639:trends; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome