title: Management of recurrent aneurysms following endovascular therapy.
abstract: The aim of the current study is to describe the complication rates and clinical outcomes in patients who either underwent repeat intervention or conservative management with radiographic surveillance when presenting with aneurysmal recurrence after endovascular treatment. Since publication of the international subarachnoid aneurysm trial (ISAT), an increasing number of patients are treated with endovascular therapy. However, recurrence after endovascular therapy continues to pose a challenge, and there is minimal evidence to guide its management. We performed a retrospective review of all patients who underwent endovascular treatment of an intracranial aneurysm from January 2005 to February 2013. The patients who had an aneurysmal recurrence following the initial endovascular treatment were identified and divided into two groups: those followed with conservative management (n=24), and those who underwent reintervention (n=65). The groups were compared for complications and clinical outcomes. When a reintervention was undertaken, microsurgical clip ligation was associated with a higher rate of occlusion than additional endovascular therapy (p<0.001). When comparing conservative treatment and reintervention, there was no statistically significant difference in complications or clinical outcomes. Reintervention was more common in patients who were younger, had presented with subarachnoid hemorrhage, or had a greater degree of recurrence. We conclude that clinical outcomes and repeat subarachnoid hemorrhage are similar in patients who underwent retreatment versus those who had conservative management for their recurrent cerebral aneurysms.
authors.affiliation: Department of Neurosurgery, University of Michigan, Room 3552, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5338, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, University of Michigan, Room 3552, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5338, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery, University of Michigan, Room 3552, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5338, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Stetler
authors.affiliation: Department of Neurosurgery, University of Michigan, Room 3552, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5338, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Davis
authors.affiliation: Department of Neurosurgery, University of Michigan, Room 3552, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5338, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Giles
authors.affiliation: Department of Neurosurgery, University of Michigan, Room 3552, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5338, USA.
authors.forename: Elyne N
authors.initials: EN
authors.lastname: Kahn
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.affiliation: Department of Neurosurgery, University of Michigan, Room 3552, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5338, USA.
authors.forename: B Gregory
authors.initials: BG
authors.lastname: Thompson
authors.affiliation: Department of Neurosurgery, University of Michigan, Room 3552, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5338, USA. Electronic address: adityap@med.umich.edu.
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000628:therapy
keywords: Cerebral aneurysm; Coil embolization; Perioperative complications; Recurrence; Subarachnoid hemorrhage; Therapeutic embolization