Endovascular coil embolization for recurrence of intracranial aneurysms more than 10 years after clipping

Abstract

We report three cases of endovascular coil embolization for recurrent cerebral aneurysm after neck clipping more than 10 years previously. In two cases, their first subarachnoid hemorrhage was treated in other hospitals and the details of follow-up after discharge were unknown. After their second subarachnoid hemorrhage recurred 15 and 30 years, respectively. The remaining patient, who was treated in our center, was followed by magnetic resonance imaging 5 years after surgery but since then she didn’t go to our center. She came to our center for follow-up examination 10 years after the first surgery. The digital subtraction angiography showed recurrence of clipped aneurysms in all patients. All of them underwent endovascular coil embolization and total obliteration of the aneurysms without complications related to the procedures. Endovascular coil embolization is an alternative modality to direct surgery for cerebral aneurysms, especially for recurrence after clipping. Endovascular coil embolization of residual aneurysms after surgery may be the treatment of choice because of the difficulties in second direct surgery. We conclude that it is necessary to perform follow-up evaluations after surgery, even if the complete obliteration of aneurysms is performed. Current medical literature does not provide recommendations for the duration of follow-up after aneurysm clipping. The authors suggest that this period perhaps be at least a decade.

Key words

Clipping - endovascular surgery - residual aneurysm - subarachnoid hemorrhage

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