gms | German Medical Science

Objective: Due to a high occlusion rate, the retreatment of intracranial aneurysm after surgical clipping is rarely required. We aimed to identify the incidence and clinical impact of aneurysm remnant after clipping in a large monocentric series.

Method: From our aneurysm databank we identified 481 of 1586 individuals admitted to our institution between January 2003 and December 2013, who were submitted for clipping and received a postoperative DSA. Medical reports and all available DSA were analyzed with regard to post-clipping remnants and their clinical consequences.

Results: Residual aneurysms, as diagnosed by the examining radiologists on the postoperative DSA, were documented in 123 cases (26%). After interdisciplinary assessment only 25 of 123 patients (20%) were suggested for retreatment of the remnants. Of them, 20 patients were subjected to early re-intervention within the same hospital stay, 5 patients were treated due to aneurysm regrowth on follow-up DSA. The need for retreatment of clip remnant was associated with the location of the aneurysm (p=0.0077): 13%:11%:4%:3% for posterior circulation, ACA, ICA and MCA branches respectively. The patients' age, gender, the presence of subarachnoid hemorrhage and multiple aneurysms were not predictive for clip remnant.

Conclusions: Our data underline the clinical importance of postoperative DSA after aneurysm clipping. In case of a suspected incomplete occlusion a follow-up with DAS is recommended to identify dynamic changes within the aneurysm remnant. Special attention should be paid to the patients with clipped aneurysms of the posterior circulation and ACA branches.