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Related Experiment Video

Updated: Mar 25, 2026

Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment

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Published on: September 25, 2009

Aneurysm remnant after clipping: the risks and consequences.

Ramazan Jabbarli¹, Daniela Pierscianek¹, Karsten Wrede¹

¹Department of Neurosurgery and.

Journal of Neurosurgery

|February 13, 2016

Summary

Clip remnants after cerebral aneurysm clipping can lead to retreatment or growth. Aneurysm size and location are key risk factors for retreatment, while younger age predicts remnant growth, necessitating long-term follow-up.

Keywords:

ACA = anterior cerebral artery AUC = area under the curve CTA = CT angiography DSA = digital subtraction angiography ICA = internal carotid artery ICG = indocyanine green MCA = middle cerebral artery PC = posterior circulation ROC = receiver operating characteristic SAH = subarachnoid hemorrhage angiographic control clipping intracranial aneurysm predictor remnant residuum rest retreatment risk factor vascular disorders

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Area of Science:

Neurosurgery
Vascular Surgery
Radiology

Background:

Complete clipping of cerebral aneurysms is crucial for sustained occlusion.
Clip remnants can have significant clinical consequences, including the need for retreatment or aneurysm growth.

Purpose of the Study:

To identify risk factors associated with cerebral aneurysm clip remnants requiring retreatment.
To determine predictors for clip remnant growth after initial aneurysm clipping.

Main Methods:

Retrospective analysis of consecutive patients undergoing primary aneurysm clipping from 2003-2013.
Assessment of aneurysm occlusion via postoperative digital subtraction angiography.
Correlation of clip remnants with patient demographics, aneurysm features, and surgical aspects.

Main Results:

18% of clipped aneurysms (112/616) had remnants requiring follow-up or retreatment.
4.5% of aneurysms (28/616) were retreated due to clip remnants.
Aneurysm size (>12 mm) and location were significant predictors for retreatment; younger age (<45 years) predicted remnant growth.

Conclusions:

Aneurysm size and location are primary risk factors for clip remnants necessitating retreatment.
Younger patients (<45 years) with clip remnants require long-term vascular surveillance due to growth risk.
Long-term follow-up (>5 years) is recommended for younger individuals with clip remnants.