The retreatment: indications, technique and results

Area of Science:

• Neurosurgery
• Interventional Neurology
• Vascular Neurology

Background:

• Durability of endovascular treatment for intracranial aneurysms is a significant concern.
• While effective, endovascular methods show higher retreatment rates (5-10x) compared to surgical clipping.
• Long-term studies confirm safety and efficacy but highlight the need for understanding retreatment factors.

Purpose of the Study:

• To analyze the durability of endovascular treatment for intracranial aneurysms.
• To identify risk factors associated with retreatment after endovascular procedures.
• To evaluate the safety and efficacy of retreatment in maintaining endovascular treatment advantages.

Main Methods:

• Review of long-term outcome studies on endovascular aneurysm treatment.
• Analysis of retreatment rates in comparison to surgical clipping.
• Identification of morphological criteria and patient-specific factors influencing retreatment necessity.

Main Results:

• Endovascular treatment is safe and effective, but retreatment is more frequent than with surgical clipping.
• Risk factors for retreatment include dissecting aneurysms, incomplete coiling, large sac size (>10mm), and bifurcation locations (e.g., basilar tip).
• Retreatment does not negate the initial benefits of endovascular treatment and can be performed with low morbidity and mortality.

Conclusions:

• Endovascular treatment for intracranial aneurysms is a viable option, though retreatment is a recognized consideration.
• Understanding specific risk factors allows for better patient selection and management strategies.
• Retreatment is a safe and effective option to ensure long-term aneurysm occlusion, preserving the advantages of endovascular therapy.