Endovascular management for retreatment of postsurgical intracranial aneurysms

Incomplete surgical treatment of intracranial aneurysms and recurrent postsurgical aneurysms are associated with a risk of rebleeding, and additional treatment is generally recommended. Surgical retreatment may carry a risk of procedural complications due to technical difficulty. We present here our experience with the endovascular approach for the retreatment of intracranial aneurysms that were initially treated with open surgery. From January 2002 through January 2013, a total of 43 patients with 43 postsurgical index aneurysms were identified and underwent subsequent endovascular treatment. Clinical and radiological data were retrospectively reviewed. Thirty-one patients were surgically clipped before endovascular coiling and 12 patients were nonclipped, which included wrapping. Hemorrhagic presentation occurred in 21 patients prior to coiling. The interval between the initial surgical treatment and coiling varied from 0 days to 264 months (median, 9 months). Endovascular coiling resulted in the successful occlusion of 36 aneurysms (84 %). Procedure-related complications included asymptomatic thrombus formation in six patients, symptomatic cerebral infarction in two patients, and retroperitoneal hemorrhage in one patient. Delayed cerebral infarction occurred in two patients with a deployed stent. The procedure-related permanent morbidity and mortality rates were 6.9 and 0 %, respectively. Radiological follow-up evaluations beyond 6 months were available in 26 patients (60 %), which revealed major recanalization in three patients (11.5 %). There was no rebleeding during the follow-up period, which ranged from 3 to 115 months (mean, 34.5 months). Endovascular embolization may serve as a safe, efficacious, and durable treatment option in the management of postsurgical intracranial aneurysms.