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Clinical presentation and outcomes of coil embolization of remnant or recurred intracranial aneurysm after clipping

 Byung Moon Kim  ;  Dong Joon Kim  ;  Dong Ik Kim  ;  Sung Il Park  ;  Sang Hyun Suh  ;  Yu Sam Won 
 NEUROSURGERY, Vol.66(6) : 1128-1133, 2010 
Journal Title
Issue Date
Adult ; Aged ; Catheters/standards ; Catheters/trends ; Cerebral Arteries/diagnostic imaging ; Cerebral Arteries/pathology ; Cerebral Arteries/surgery* ; Embolization, Therapeutic/instrumentation* ; Embolization, Therapeutic/methods* ; Female ; Humans ; Intracranial Aneurysm/diagnosis* ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/surgery* ; Male ; Middle Aged ; Outcome Assessment (Health Care)/methods* ; Prostheses and Implants ; Radiography ; Reoperation/instrumentation ; Reoperation/trends ; Secondary Prevention ; Stents/standards ; Stents/trends ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/pathology ; Subarachnoid Hemorrhage/surgery ; Vascular Surgical Procedures/instrumentation* ; Vascular Surgical Procedures/methods*
OBJECTIVE: To evaluate clinical presentation, safety, techniques, clinical and angiographic outcomes, and prognostic factors of coiling for remnant/recurred aneurysm after clipping. METHODS: Twenty-four consecutive patients (11 men and 13 women; mean age, 52 years) with 24 recurred/remnant aneurysms after clipping underwent coil embolization between September 2000 and December 2008. Clinical presentations of remnant/recurred aneurysms, safety, techniques, clinical and angiographic outcomes, and prognostic factors of coil embolization were retrospectively evaluated. RESULTS: Twenty-two aneurysms initially presented with subarachnoid hemorrhage and the other two, with mass effect. Eight aneurysms presented with rebleeding and 16 aneurysms were found on follow-up CT angiogram (n = 12) or catheter angiogram (n = 4). The interval between clipping and coiling ranged from 8 days to 114 months (mean, 31 months). Twelve were treated by using single-catheter, 6 by stent-assisted, 4 by multicatheter, 1 by both balloon- and catheter-assisted, and 1 by balloon-in-stent technique. Immediate postembolization angiogram revealed complete obliteration (n = 19) or residual neck (n = 5). Procedure-related permanent morbidity and mortality rates were 4.2% (1 of 24) and 0%, respectively. There was no rebleeding during clinical follow-up for 3 to 82 months (mean, 24 months). Presentation with rupture after clipping was the only significant predictor of poor outcome (P < .05). CONCLUSION: Coiling seems to be a safe and effective retreatment option for remnant/ recurred aneurysm after clipping. Presentation with rupture after clipping is the only predictor of poor outcome. For routine/regular follow-up after clipping, CT angiography may be the imaging modality advisable for detection of remnant/recurred aneurysm.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
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