title: A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation.
abstract: OBJECTIVE With the recent evolution of endovascular therapies, objective evaluation of the efficacy of clip ligation for cerebral aneurysms should be performed. This study was undertaken to evaluate the durability of microsurgical clip ligation, identify risk factors for recurrence, and assess the need for long-term follow-up imaging. METHODS A retrospective review of medical records identified 616 consecutive patients (156 male and 460 female patients; mean age 48.4 ± 12.4 years; range 6-90 years) who underwent microsurgical clip ligation and follow-up imaging at least 1 year after discharge between 1990 and 2010 at our institution. Of a total of 926 aneurysms in 616 patients, 758 aneurysms were microsurgically clip-ligated. At presentation, 431 of these aneurysms were ruptured and 327 aneurysms were unruptured. All patients underwent postoperative baseline imaging within the 1st month of their operation. A logistic regression analysis was performed to identify which variables are more likely to predict recurrence. RESULTS Late follow-up angiographic imaging was obtained at a mean of 7.2 ± 4.7 years postdischarge (median 5.7 years; range 1-23 years). Of the 699 clipped aneurysms without residua, late follow-up angiography revealed only 1 (0.14%) recurrent aneurysm. Of the 59 residual aneurysms that remained after initial clip ligation on early postoperative imaging, 8 (13.6%) demonstrated growth. All of these aneurysms required treatment. None of the recurrences were due to broken or delayed displacement of clips. A total of 111 patients presented with multiple aneurysms. De novo aneurysm formation occurred in 8 (0.97%) patients, all of whom initially presented with multiple aneurysms. CONCLUSIONS This study provides additional evidence to support the long-term efficacy of aneurysm clip ligation. The chance of aneurysm recurrence after complete clip ligation is very small. However, there is a regrowth risk of 1.83% per year for aneurysm remnants after incomplete clip ligation. These findings support the necessity for continued followup, late angiographic imaging, and the potential need for further intervention of incompletely ligated aneurysms. Furthermore, completely clip-ligated aneurysms may not require additional surveillance imaging unless multiple aneurysms were evident at presentation.
authors.affiliation: Goodman Campbell Brain and Spine, and Department of Neurosurgery, Indiana University, Indianapolis, Indiana; and.
authors.forename: Mason A
authors.initials: MA
authors.lastname: Brown
authors.affiliation: Goodman Campbell Brain and Spine, and Department of Neurosurgery, Indiana University, Indianapolis, Indiana; and.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Parish
authors.affiliation: Goodman Campbell Brain and Spine, and Department of Neurosurgery, Indiana University, Indianapolis, Indiana; and.
authors.forename: Cristian F
authors.initials: CF
authors.lastname: Guandique
authors.affiliation: Goodman Campbell Brain and Spine, and Department of Neurosurgery, Indiana University, Indianapolis, Indiana; and.
authors.forename: Troy D
authors.initials: TD
authors.lastname: Payner
authors.affiliation: Goodman Campbell Brain and Spine, and Department of Neurosurgery, Indiana University, Indianapolis, Indiana; and.
authors.forename: Terry
authors.initials: T
authors.lastname: Horner
authors.affiliation: Goodman Campbell Brain and Spine, and Department of Neurosurgery, Indiana University, Indianapolis, Indiana; and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Leipzig
authors.affiliation: Goodman Campbell Brain and Spine, and Department of Neurosurgery, Indiana University, Indianapolis, Indiana; and.
authors.forename: Karishma V
authors.initials: KV
authors.lastname: Rupani
authors.affiliation: Goodman Campbell Brain and Spine, and Department of Neurosurgery, Indiana University, Indianapolis, Indiana; and.
authors.forename: Richard
authors.initials: R
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Bohnstedt
authors.affiliation: Goodman Campbell Brain and Spine, and Department of Neurosurgery, Indiana University, Indianapolis, Indiana; and.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D008026:Ligation; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: CTA = CT angiography; DSA = digital subtraction angiography; ISAT = International Subarachnoid Aneurysm Trial; SAH = subarachnoid hemorrhage; aneurysm; angiography; clip ligation; follow-up; recurrence; subarachnoid hemorrhage; vascular disorders