Endovascular management for retreatment of postsurgical intracranial aneurysms.
BACKGROUND
Incomplete surgical treatment of intracranial aneurysms and recurrent postsurgical aneurysms are associated with a risk of rebleeding, and additional treatment is generally recommended. Surgical retreatment may carry a risk of procedural complications due to technical difficulty. We present here our experience with the endovascular approach for the retreatment of intracranial aneurysms that were initially treated with open surgery.


METHODS
From January 2002 through January 2013, a total of 43 patients with 43 postsurgical index aneurysms were identified and underwent subsequent endovascular treatment. Clinical and radiological data were retrospectively reviewed.


RESULTS
Thirty-one patients were surgically clipped before endovascular coiling and 12 patients were nonclipped, which included wrapping. Hemorrhagic presentation occurred in 21 patients prior to coiling. The interval between the initial surgical treatment and coiling varied from 0 days to 264 months (median, 9 months). Endovascular coiling resulted in the successful occlusion of 36 aneurysms (84 %). Procedure-related complications included asymptomatic thrombus formation in six patients, symptomatic cerebral infarction in two patients, and retroperitoneal hemorrhage in one patient. Delayed cerebral infarction occurred in two patients with a deployed stent. The procedure-related permanent morbidity and mortality rates were 6.9 and 0 %, respectively. Radiological follow-up evaluations beyond 6 months were available in 26 patients (60 %), which revealed major recanalization in three patients (11.5 %). There was no rebleeding during the follow-up period, which ranged from 3 to 115 months (mean, 34.5 months).


CONCLUSIONS
Endovascular embolization may serve as a safe, efficacious, and durable treatment option in the management of postsurgical intracranial aneurysms.
Department of Interventional Radiology, 1st Affiliated Hospital of Dalian Medical University, Dalian, China.
Ke
K
Li
Young Dae
YD
Cho
Hyun-Seung
HS
Kang
Jeong Eun
JE
Kim
Moon Hee
MH
Han
Yong Man
YM
Lee
D002548:Cerebral Revascularization / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods*; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome