Article
Retreatment of previously coiled aneurysms – risk assessment
Nachbehandlung von gecoilten Aneurysmen – eine Risikoabschätzung
Search Medline for
Authors
-
M.T. Pedro
- Neurochirurgische Klinik der Universität Ulm / BKH Günzburg
-
T. Kretschmer
- Neurochirurgische Klinik der Universität Ulm / BKH Günzburg
-
C. Heinen
- Neurochirurgische Klinik der Universität Ulm / BKH Günzburg
-
T. Schmidt
- Neurochirurgische Klinik der Universität Ulm / BKH Günzburg
-
H.-P. Richter
- Neurochirurgische Klinik der Universität Ulm / BKH Günzburg
-
G. Antoniadis
- Neurochirurgische Klinik der Universität Ulm / BKH Günzburg
-
R. W. König
- Neurochirurgische Klinik der Universität Ulm / BKH Günzburg
| Published: | May 30, 2008 |
|---|
Outline
Text
Objective: To analyze the risk of retreatment of recanalized aneurysms previously coiled.
Methods: We report a series of 27 patients who needed retreatment because of progressive recanalization after primary coil embolization between 2000 and 10/2007 emphasizing the special risks and complications.
The series described consists of 12 patients,who were primarily coiled for incidental aneurysms, and 15 patients coiled because of subarachnoid hemorrhage (SAH). 3 patients presented with re-hemorrage, 24 showed progressive reperfusion of their aneurysms during follow-up. 17 aneurysms were located in the anterior, 10 in the posterior circulation.
Results: As a secondary procedure, recoiling (partially repeatedly) was performed in 9, stent-assisted recoiling in 8 and clipping in 10 cases. 3 patients had to be retreated multiple times because of repeated reperfusion, one paraophthalmic ACI-aneurysm for example still reveals incomplete embolization after a total of 4 interventions. One of the patients clipped had a transient aphasia in the early postoperative period with subsequent full recovery, another showed infarction of one of the anteromedial arteries on imaging without any neurological impairment. One of the patients treated with an intervention developed hematoma of the right groin after puncture of the femoral artery which needed emergency surgery, 2 patients treated by stent-assisted recoiling had a TIA with subsequent full recovery, one patient treated by recoiling alone developed a partial infarction of the right anterior cerebral artery territory.
Though most of the adverse events reported in this study were transient, the overall complication rate of this series is as high as 22,2%. Permanent deficits attributable to the retreatment of a recanalized aneurysm occurred in one patient (3,7%).
Conclusions: Reperfusion of previously coiled aneurysms remains a problem, even when new endovascular techniques lower its risk. The risk of reperfusion and the risk of aneurysm retreatment independent of the procedure used has to be considered especially in incidental aneurysms.
In case of reperfusion, recoiling is generally considered to be the treatment of first choice, but individual factors such as the angioarchitecture, the patients' age and the localisation of the aneurysm (posterior/ anterior circulation) have to be respected.
