Endovascular Retreatment of Previously Ruptured Coiled Cerebral Aneurysm Remnants Significantly Reduces Rebleed Rate

Area of Science:

• Neurosurgery
• Endovascular Therapy
• Cerebrovascular Disease

Background:

• Endovascular coiling offers better neurologic outcomes for ruptured cerebral aneurysms than surgical clipping.
• However, coiling is associated with a higher risk of aneurysm rebleeding post-treatment.

Purpose of the Study:

• To investigate if aggressive retreatment of coiled aneurysms reduces recurrent hemorrhage rates.
• To compare rebleeding rates with historical data and neurosurgical clipping outcomes.

Main Methods:

• Retrospective review of 214 first-time endovascularly coiled cerebral aneurysms (2004-2015).
• Recorded retreatment instances, time to retreatment, and causes (incomplete coiling, coil compaction, dilatation).
• Kaplan-Meier analysis assessed embolization durability.

Main Results:

• 46% of aneurysms required retreatment due to patency or recanalization.
• Mean time to retreatment was 9 months.
• Only 0.9% experienced recurrent hemorrhage, successfully treated with additional coiling; no new deficits occurred.

Conclusions:

• Aggressive retreatment of coiled aneurysms for persistent patency minimizes recurrent hemorrhage risk.
• This strategy achieves rebleeding rates similar to neurosurgical clipping with low morbidity.
• Confirms the importance of addressing post-treatment aneurysm remnants to prevent rebleeding.