Original ArticleMicrosurgical Treatment of Previously Coiled Intracranial Aneurysms: Systematic Review of the Literature
Introduction
The endovascular treatment of intracranial aneurysms was first introduced by Serbinenko in 1974 (51) and has seen several major advancements since that time. As the widespread use of endovascular coiling continues to increase, so does the population of patients who require retreatment for incomplete occlusion or recurrence. The International Subarachnoid Aneurysm Trial (ISAT) reported a 34% combined rate of aneurysm subtotal occlusion and refilling after endovascular coiling (37). The Cerebral Aneurysm Rerupture After Treatment (CARAT) study reported annual retreatment rates of coiled aneurysms of 13.3%, 4.5%, and 1.1% during the first, second, and subsequent years (22). Although the natural history of previously coiled aneurysms with remnants and aneurysms demonstrating regrowth has not been fully elucidated 5, 22, 47, 55, significant residual aneurysm filling has been linked to hemorrhage and mass effect symptoms, particularly in previously ruptured aneurysms 6, 7, 49. Approximately one third of residual lesions show evidence of progressive growth, which may be an indication for retreatment 10, 19. At the present time, retreatment options for previously coiled intracranial aneurysms include repeat endovascular treatment, with or without adjunctive endovascular devices; microsurgical clipping; and parent artery occlusion. Revascularization techniques may be needed when occlusion of a parent artery is planned. The evidence for microsurgical retreatment of previously coiled intracranial aneurysms is sparse, and guidelines are lacking. We aimed to review systematically the English-language literature on this issue with a focus on indications, complications, outcomes, and technical nuances.
Section snippets
Materials and Methods
A search strategy was designed to identify relevant reports on microsurgical treatment of previously coiled intracranial aneurysms. The search was restricted to English-language articles published between January 1990 and December 2013. Articles were identified from PubMed/MEDLINE and EMBASE databases using the key terms “intracranial aneurysm,” “coil embolization,” “endovascular surgery,” “aneurysm recurrence,” and “surgical clipping.” Additional sources were identified from manual review of
Epidemiology
We identified 27 articles; 1 was excluded for exclusively using embolization material other than coils (26), and 1 was excluded for overlapping patient data that were updated in a more recent publication (27). After manual review of bibliographies, 4 additional studies were identified 2, 21, 32, 55. The 29 studies that were included are listed in Table 1 2, 3, 6, 7, 8, 11, 12, 16, 17, 18, 21, 24, 25, 27, 29, 30, 32, 36, 39, 42, 46, 49, 50, 52, 53, 54, 56, 59, 61. Table 2 summarizes data from
Discussion
As endovascular coil embolization for the treatment of intracranial aneurysms has become more prevalent, the number of intracranial aneurysms requiring retreatment has increased (56). Indications for retreatment include incomplete obliteration, subsequent growth of residual neck or dome, and coil compaction resulting in fundal refilling 10, 21, 52. Incomplete aneurysm treatment associated with coil embolization as well as aneurysm recurrence may necessitate subsequent microsurgical treatment
Conclusions
Although advances have occurred in the endovascular treatment of intracranial aneurysms, microsurgery remains an important technique for managing many aneurysms, including aneurysms for which endovascular treatment fails. A significant number of patients treated with endovascular coil embolization have incomplete occlusion, with some developing recanalization and growth of lesions warranting consideration of repeat treatment. Although current understanding of the natural history of neck
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Clinical Trials of Microsurgery for Cerebral Aneurysms: Past and Future
2022, World NeurosurgerySurgical Treatment of Recurrent Previously Coiled and/or Stent-Coiled Intracerebral Aneurysms: A Single-Center Experience in a Series of 75 Patients
2019, World NeurosurgeryCitation Excerpt :Our overall obliteration rate of approximately 85% is slightly inferior to other large studies. A large systematic review13 reported a 93% obliteration overall rate, with 42% of the investigators reporting 100% obliteration. Similarly, Daou et al.11 recently showed a 97.3% aneurysm occlusion rate in a series of 111 patients.
Microsurgical Treatment of Cerebral Aneurysms After Previous Endovascular Therapy: Single-Center Series and Systematic Review
2019, World NeurosurgeryCitation Excerpt :Although associated with improved mortality 1 year after initial treatment,3 endovascular embolization also confers higher risk of aneurysm recurrence and rerupture in the setting of incomplete occlusion.4,7-11 More than one third of aneurysms treated by endovascular coiling show subtotal occlusion or refilling.1,3 Furthermore, the CARAT (Cerebral Aneurysm Rerupture After Treatment) study reported annual retreatment rates as high as 13.3%.4,12,13
Safety and Efficacy of Surgical Treatment of Intracranial Aneurysms: The Experience of a Single Brazilian Center
2018, World NeurosurgeryCitation Excerpt :The results of numerous studies, represented mainly by the International Subarachnoid Aneurysm Trial (ISAT),10 have shown lower morbidity and mortality with endovascular treatment in ruptured aneurysms, leading to increasing use of this technique. However, more recently, several articles reporting on the long-term follow-up of patients submitted to the endovascular technique have shown that although this technique is safe in the short term, it can result in significant rates of aneurysm recanalization.11-13 In the present study, patients with ruptured and unruptured aneurysms were selected based on their medical records; however, because these are relatively distinct diseases, few studies in the literature have compared the 2 entities and analyzed the overall evolution of patients treated microsurgically and factors associated with treatment outcomes.
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.