title: Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients.
abstract: OBJECTIVE With the increasing number of aneurysms treated with endovascular coiling, more recurrences are being encountered. The aim of this study was to evaluate the efficacy and safety of microsurgical clipping in the treatment of recurrent, previously coiled cerebral aneurysms and to identify risk factors that can affect the outcomes of this procedure. METHODS One hundred eleven patients with recurrent aneurysms whose lesions were managed by surgical clipping between January 2002 and October 2014 were identified. The rates of aneurysm occlusion, retreatment, complications, and good clinical outcome were retrospectively determined. Univariate and multivariate logistic regressions were performed to identify factors associated with these outcomes. RESULTS The mean patient age was 50.5 years, the mean aneurysm size was 7 mm, and 97.3% of aneurysms were located in the anterior circulation. The mean follow-up was 22 months. Complete aneurysm occlusion, as assessed by intraoperative angiography, was achieved in 97.3% of aneurysms (108 of 111 patients). Among patients, 1.8% (2 of 111 patients) had a recurrence after clipping. Retreatment was required in 4.5% of patients (5 of 111) after clipping. Major complications were observed in 8% of patients and mortality in 2.7%. Ninety percent of patients had a good clinical outcome. Aneurysm size (OR 1.4, 95% CI 1.08-1.7; p = 0.009) and location in the posterior circulation were significantly associated with higher complications. All 3 patients who had coil extraction experienced a postoperative stroke. Aneurysm size (OR 1.2, 95% CI 1.02-1.45; p = 0.025) and higher number of interventions prior to clipping (OR 5.3, 95% CI 1.3-21.4; p = 0.019) were significant predictors of poor outcome. An aneurysm size > 7 mm was a significant predictor of incomplete obliteration and retreatment (p = 0.018). CONCLUSIONS Surgical clipping is safe and effective in treating recurrent, previously coiled cerebral aneurysms. Aneurysm size, location, and number of previous coiling procedures are important factors to consider in the management of these aneurysms.
authors.affiliation: Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and.
authors.forename: Badih
authors.initials: B
authors.lastname: Daou
authors.affiliation: Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: University of Virginia, Charlottesville, Virginia.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Barros
authors.affiliation: Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and.
authors.forename: Lina
authors.initials: L
authors.lastname: Ya'qoub
authors.affiliation: Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and.
authors.forename: John
authors.initials: J
authors.lastname: Do
authors.affiliation: Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.affiliation: Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.affiliation: Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: ACoA = anterior communicating artery; PCoA = posterior communicating artery; PED = Pipeline Embolization Device; aneurysm; clipping; mRS = modified Rankin Scale; previously coiled; recurrence; vascular disorders