Coiling of cerebral aneurysm remnants after clipping

During the past decade, options for the management of aneurysm remnants after clipping have expanded. Advances in aneurysm coiling techniques and technology have allowed for more remnants to be treated safely. We present our experience with this approach and discuss its indications, limitations, and results.

We retrospectively reviewed the Northwestern Memorial Hospital experience with aneurysm coiling between January 1996 and June 2001. We identified five patients who underwent coiling for aneurysm remnants after clipping. We reviewed the clinical history, all follow-up notes, and all relevant imaging studies. We also reviewed MEDLINE for all articles published in the English language between 1990 and September 2001 that included patients treated with this approach.

Complete to near-complete aneurysm occlusion was achieved in all five patients in our study. There was no permanent morbidity or mortality associated with the procedure in any of these patients. In the literature, we found seven articles that discuss 21 patients who were treated with coiling for their remnants. There were no permanent complications reported for these 21 patients. Adequate long-term follow-up in these 21 patients, however, is lacking.

Complete aneurysm occlusion is the goal of aneurysm clipping. When this goal cannot be achieved safely, coiling of the remnant, if size and morphology are amenable, is a safe option that should be considered. Clinical and angiographic long-term follow-up of patients treated in this manner should be studied and reported.