抄録
Considering the excellent results of coil embolization in several clinical studies for cerebral aneurysms, endovascular treatment has often been selected as the first-choice treatment of cerebral aneurysms, even in Japan. However, recurrence, which occurs at a certain probability after coil embolization, is a crucial problem. As a result of the increased use of endovascular treatment, we have experienced increased frequency of recurrent aneurysms after coil embolization.
Many authors have reported that re-coil embolization is safe and efficient for the treatment of recurrent aneurysms after coil embolization. On the other hand, surgical clipping is an alternative option for retreatment, especially in cases unsuitable for coil embolization. Surgical clipping for recurrent aneurysms after coil embolization is performed with or without removal of embolized coils. However, removal of embolized coils entails management of some uncertain elements during the procedure. Therefore, when technically feasible, clipping without removal of embolized coils is preferred.
We present our experience with retreatment of 24 cerebral aneurysms after coiling between 2009 and 2015. Among the 24 aneurysms, 12 were retreated with coiling, and 12 were retreated with clipping. Among the 12 cases with clipping, 10 involved neck clipping and two involved partial clipping of the non-thrombosed portion. In all the cases, clipping was accomplished without coil removal. No neurological complications occurred in any of the cases retreated with surgical clipping.
The management of recurrent lesions of embolized aneurysms requires appropriate choice of treatment that involves using coiling as well as clipping. In these cases, surgical clipping, especially without coil removal, plays an important role in ensuring safe treatment.
