Late angiographic follow-up review of surgically treated aneurysms

David, Carlos A.; Vishteh, A. Giancarlo; Spetzler, Robert F.; Lemole, Michael; Lawton, Michael T.; Partovi, Shahram

doi:10.3171/jns.1999.91.3.0396

Cited by 442 publications

(300 citation statements)

References 16 publications

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“…[6][7][8] This efficacy is preserved with a 0.5% rate of recurrence per year in completely clipped aneurysms. 6 Most importantly, microsurgical clipping significantly changes the natural history of the disease. Over a 4.4-year follow-up period of patients with ruptured aneurysms, David and colleagues reported a 0% incidence of rebleeding in 147 aneurysms that had been completely clipped.…”

Section: Comparison Of Endovascular Occlusion and Microsurgical Exclumentioning

confidence: 99%

“…Combined, these residuals had a recurrent bleeding rate of 1.5% per year in the 8.2% of aneurysms with residual necks after clipping. 6 The impact of microsurgical clipping in altering the natural history has also been found in unruptured intracranial aneurysms (UIAs).…”

Section: Comparison Of Endovascular Occlusion and Microsurgical Exclumentioning

confidence: 99%

“…Over a 4.4-year follow-up period of patients with ruptured aneurysms, David and colleagues reported a 0% incidence of rebleeding in 147 aneurysms that had been completely clipped. 6 Twelve (8.2%) of the 147 aneurysms had a residual neck, and these were divided into two groups: dog ear residua and broad-based residua. Patients with the dog-ear type had a 1.9% annual risk of recurrent hemorrhage, and patients with the broad-based type had no recurrent hemorrhage although they had significant regrowth.…”

Section: Comparison Of Endovascular Occlusion and Microsurgical Exclumentioning

confidence: 99%

See 2 more Smart Citations

Adenosine-Induced Transient Asystole

Britz

2014

Methodist DeBakey Cardiovascular Journal

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Section: Comparison Of Endovascular Occlusion and Microsurgical Exclumentioning

confidence: 99%

Section: Comparison Of Endovascular Occlusion and Microsurgical Exclumentioning

confidence: 99%

Section: Comparison Of Endovascular Occlusion and Microsurgical Exclumentioning

confidence: 99%

See 1 more Smart Citation

Adenosine-Induced Transient Asystole

Britz

2014

Methodist DeBakey Cardiovascular Journal

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“…The patient having clipped aneurysm might have thus, like in this case, following risks concerning new aneurysm formation on the long term followup: recurrent aneurysm at completely clipped and/or incompletely clipped aneurysm, and de novo aneurysm. Although the frequency of aneurysm recurrence after complete clipping is difficult to determine, their incidence have been reported to be around 0.26-0.53 % annually [2,3,4]. Surgical treatment for regrowth of a previously clipped aneurysm is regarded to be one of the most difficult procedures in aneurysm surgery.…”

Section: Introductionmentioning

confidence: 99%

Recurrent Intracranial Aneurysms After Successful Neck Clipping

et al. 2010

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BACKGROUND: To report the authors' experience with recurrent aneurysms after primarily completely clipped cerebral aneurysms and discuss mechanisms of recurrence and recommended management. METHODS: Data were available for 1016 consecutive patients who underwent clipping of ruptured and unruptured aneurysms in a 15-year period from 1993-2007. RESULTS: Nine patients were treated for recurrent aneurysms after successful complete clipping of the initial aneurysms; six patients had initial surgery before 1992, and three patients underwent surgery during the study period. Mean elapsed time between the first clipping and the recurrence of aneurysm was 13.3 years ± 7.8. Repeat craniotomy was performed in seven patients, and six patients underwent reclipping of aneurysms with or without removal of the old clips. One patient was treated by construction of an extracranial-intracranial (EC-IC) bypass plus coating of the aneurysm. Endovascular occlusion of the parent artery was performed in one patient. One patient died without any intervention. Recurrent aneurysms could be classified into three types according to the relationship of the new aneurysm neck to the old clip. CONCLUSIONS: The incidence of recurrent aneurysms after complete clipping was approximately 0.02% per year; aneurysms recurred after 13.3 years on average with 25 years the longest duration from initial clipping to recurrence. Classification of recurrent aneurysms into three types might be helpful in selecting appropriate surgical management. patients underwent reclipping of the aneurysms with or without removal of the old clips.One patient was treated by construction of extracranial-intracranial EC-IC bypass plus coating of the aneurysm. Endovascular occlusion of the parent artery was performed in one patient and the rest one patient expired without any. Recurrent aneurysms could be classified into 3 types according to the relation of their new aneurysm neck to the old clip.Conclusion: Recurrent aneurysms after complete clipping occurred around 0.02 %/year and took place after a period of 25 years at longest and 13.3 years on the average.Classification of recurrent aneurysms into three types might serve to select their appropriate surgical management.

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“…8,11) Both de novo aneurysm and regrowth of a previously clipped aneurysm are potential origins of subarachnoid hemorrhage. 1,4,6,7,9,13,[15][16][17] Postoperative 3D computed tomography angiography and conventional angiography indicate that 5.9-42% of residual aneurysm persists after clipping. 6,13) A small remnant is thought to pose little risk, 13) but residual neck can dilate and form a dangerous aneurysm after a long period, even if the remnant is only 1-2 mm in size.…”

Section: Introductionmentioning

confidence: 99%

Concept of Ideal Closure Line for Clipping of Middle Cerebral Artery Aneurysms -Technical Note-

Ishikawa

Nakayama

Moroi

et al. 2009

Neurol. Med. Chir.(Tokyo)

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The concept of optimum closure line was applied to a series of 51 consecutive middle cerebral artery aneurysms (14 ruptured, 37 unruptured) in 41 patients, 16 men and 25 women aged 29-79 years (mean 59.1 years). Visual inspection through the operating microscope revealed 3 types of aneurysm based on the origin of the aneurysm: bifurcation type (n ＝ 39), trunk type (n ＝ 9), and combined type (n ＝ 3). Clipping along the optimum closure line should restore the vascular structure to the original configuration. Combination clip techniques were useful to form a curved closure line. This technique requires adequate operative fields with dissection of the aneurysm and related arteries from the neighboring structures as far as possible. The closure line concept is helpful to decide how to apply clips for particular aneurysms to avoid risks of ischemic complication and future recurrence. Combination clip techniques are often necessary to match a curved closure line.

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Late angiographic follow-up review of surgically treated aneurysms

Cited by 442 publications

References 16 publications

Adenosine-Induced Transient Asystole

Adenosine-Induced Transient Asystole

Recurrent Intracranial Aneurysms After Successful Neck Clipping

Concept of Ideal Closure Line for Clipping of Middle Cerebral Artery Aneurysms -Technical Note-

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