Abstract
Objective: We investigate the efficacy of endovascular surgery (EVS) for the residual aneurysms following surgical clipping.
Materials and Methods: Between April 1999 and May 2009, we performed endovascular treatment in 17 consecutive patients with residual aneurysms following surgical clipping. They comprised 6 men and 11 women with a mean age of 59 years. Of the 17 aneurysms, 10 were ruptured, the other 7 were unruptured, and were located at IC-PC (5), VA-PICA (4), AcomA (4), BA-tip (2), MCA (1), and BA-SCA (1). The direction of the dislocated clip was divided into 3 types: type A (n=2) the clip dislocated along with the aneurysmal neck, type B (n=6) the clip dislocated to the fundus, and type C (n=9) the clip completely dislocated from the aneurysm.
Results: The interval between clipping and EVS ranged from 6 days to 17 years (mean 4.7 years). Of 17 aneurysms, 14 were small (< 10 mm)and 3 were large (10 - 25 mm). As for type of clip dislocations; 2 were type A (11.8%), 6 were type B (35.3%), and 9 were type C (52.9%). EVS was successful in 16 of 17 cases (94.1%). Of 16 aneurysms in which EVS was successful, 12 were completely occluded and 4 were neck remnant. There were no procedural complications. Coil compaction was observed in one patient during the follow-up period.
Conclusion: EVS is a safe and effective method for residual aneurysms following surgical clipping. 3D rotational angiography is useful to clarify aneurysmal morphology and facilitates successful occlusion of the residual aneurysm.
