title: Aneurysm remnant after clipping: the risks and consequences.
abstract: OBJECTIVE The complete clipping of a cerebral aneurysm usually warrants its sustained occlusion, while clip remnants may have far-reaching consequences. The aim of this study is to identify the risk factors for clip remnants requiring retreatment and/or exhibiting growth. METHODS All consecutive patients with primary aneurysm clipping performed at University Hospital of Essen between January 1, 2003, and December 31, 2013, were eligible for this study. Aneurysm occlusion was judged on obligatory postoperative digital subtraction angiography and the need for repeated vascular control. The identified clip remnants were correlated with various demographic and clinical characteristics of the patients, aneurysm features, and surgery-related aspects. RESULTS Of 616 primarily clipped aneurysms, postoperative angiography revealed 112 aneurysms (18%) with clip remnants requiring further control (n = 91) or direct retreatment (n = 21). Seven remnants exhibited growth during follow-up, whereas 2 cases were associated with aneurysmal bleeding. Therefore, a total of 28 aneurysms (4.5%) were retreated as clip remnants (range 1 day to 67 months after clipping). In the multivariate analysis, the need for retreatment of clip remnant was correlated with the aneurysm's initial size (> 12 mm; OR 3.22; p = 0.035) and location (anterior cerebral artery > internal carotid artery > posterior circulation > middle cerebral artery; OR 1.85; p = 0.003). Younger age with a cutoff at 45 years (OR 33.31; p = 0.004) was the only independent predictor for remnant growth. CONCLUSIONS The size and location of the aneurysm are the main risk factors for clip remnants requiring retreatment. Because of the risk for growth, younger individuals (< 45 years old) with clip remnants require a long-term (> 5 years) vascular follow-up. Clinical trial registration no: DRKS00008749 (Deutsches Register Klinischer Studien).
authors: Department of Neurosurgery and.
authors: Ramazan
authors: R
authors: Jabbarli
authors: Department of Neurosurgery and.
authors: Daniela
authors: D
authors: Pierscianek
authors: Department of Neurosurgery and.
authors: Karsten
authors: K
authors: Wrede
authors: Department of Neurosurgery and.
authors: Philipp
authors: P
authors: Dammann
authors: Institute for Diagnostic and Interventional Radiology, University Hospital of Essen, Germany.
authors: Marc
authors: M
authors: Schlamann
authors: Institute for Diagnostic and Interventional Radiology, University Hospital of Essen, Germany.
authors: Michael
authors: M
authors: Forsting
authors: Department of Neurosurgery and.
authors: Oliver
authors: O
authors: Müller
authors: Department of Neurosurgery and.
authors: Ulrich
authors: U
authors: Sure
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult
keywords: ACA = anterior cerebral artery; AUC = area under the curve; CTA = CT angiography; DSA = digital subtraction angiography; ICA = internal carotid artery; ICG = indocyanine green; MCA = middle cerebral artery; PC = posterior circulation; ROC = receiver operating characteristic; SAH = subarachnoid hemorrhage; angiographic control; clipping; intracranial aneurysm; predictor; remnant; residuum; rest; retreatment; risk factor; vascular disorders