• Jonathan J Liu, Troels H Nielsen, Kumar Abhinav, Justin Lee, Summer S Han, Michael P Marks, Huy M Do, Robert L Dodd, and Gary K Steinberg.
• Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA.
• World Neurosurg. 2019 Apr 1; 124: e649e658e649-e658.

BackgroundEndovascular treated cerebral aneurysms have a greater recurrence rate compared with microsurgical clip ligation. Despite recent endovascular advances, microsurgical clip ligation might be the treatment of choice for certain previously endovascular treated recurrent aneurysms. We report on our single-center experience with 76 previously coiled and/or stent-coiled aneurysms.ObjectiveTo analyze the surgical and radiologic outcome after clipping of previous endovascular treated recurrent cerebral aneurysms.MethodsPatients were retrospectively identified. Demographic data, aneurysm size, location, perioperative coil extraction, occlusion rate, and complication rate were recorded. Patients were divided into a previously coiled-only group (COG) and a previously stent-assisted coiled group (SAC).ResultsSeventy-five patients with 76 aneurysms were included. Sixty-nine patients were included in the COG, 7 patients in the SAC group. Complete or acceptable near-complete occlusion was obtained in 95% of patients in the COG and 57% in the SAC group. Two patients in the COG (2.9%) died postoperatively of a major stroke. One patient died of rehemorrhage after wrapping of an aneurysm. Minor complications occurred in 8.7%. In the SAC group, the mortality was 0%, with 1 major stroke (14.2%), 1 minor stroke (14.2%), and 1 cranial nerve palsy (14.2%). Intraoperative coil extraction and previous stent-assisted coiling were significant predictors of complication rate (P = 0.025 and P = 0.0036 respectively). Previous stent-assisted coiling was a significant predictor of incomplete occlusion (P = 0.036).ConclusionsMicrosurgical clipping of previously endovascular treated recurrent aneurysms is an effective treatment with high obliteration rates. Previously stent-assisted coiling and intraoperative coil extraction are predictors of worse outcome and incomplete occlusion.Published by Elsevier Inc.

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