Microsurgical clipping for recurrent aneurysms after initial endovascular coil embolization

Area of Science:

• Neurosurgery
• Endovascular Surgery
• Vascular Neurology

Background:

• Recurrent aneurysms after coil embolization pose surgical challenges due to scarred coil masses adherent to vital structures.
• Assessing the efficacy and safety of microsurgical clipping without coil removal is crucial for managing these complex cases.

Observation:

• Seven patients with recurrent embolized aneurysms underwent microsurgical treatment, with 6 receiving clipping and 1 undergoing parent artery occlusion.
• Aneurysm recurrence mechanisms included coil compaction, regrowth, and migration, with a median latency of 28.8 months.
• Fenestrated clips were successfully used in 4 patients for direct neck clipping.

Findings:

• Microsurgical clipping without coil removal resulted in complete aneurysm occlusion in all patients.
• No postoperative morbidity was observed, and no recurrences occurred during a mean follow-up of 44.7 months.
• Parent artery occlusion under bypass protection is a viable option for unclippable lesions.

Implications:

• Microsurgical clipping without coil removal is a safe and effective strategy for recurrent aneurysms when technically feasible.
• Tandem clipping with fenestrated clips is key for direct neck clipping in previously coiled aneurysms.
• Alternative strategies like parent artery occlusion are important for complex cases.