Treatment of Recurrent Intracranial Aneurysms After Clipping: A Report of 23 Cases and a Review of the Literature

Hokari, Masaaki; Kazumara, Ken; Nakayama, Naoki; Ushikoshi, Satoshi; Sugiyama, Taku; Asaoka, Katsunori; Uchida, Kei; Shimbo, Daisuke; Itamoto, Koji; Yokoyama, Yuka; Isobe, Masanori; Imai, Tetsuaki; Osanai, Toshiya; Houkin, Kiyohiro

doi:10.1016/j.wneu.2016.05.053

Cited by 18 publications

(16 citation statements)

References 24 publications

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“…However, considering previous reports on this issue, revised microsurgical clipping in this condition seems to be a complicated and an eventually challenging process. 8,9 In addition, our procedural morbidity rate was not higher than that for the initial coil embolization of ruptured or unruptured cerebral aneurysms. 7,10 Accordingly, coil embolization may be a feasible treatment option for recurrent cerebral aneurysms treated primarily by surgical clipping.…”

Section: Discussionmentioning

confidence: 65%

Coil Embolization in Patients with Recurrent Cerebral Aneurysms Who Previously Underwent Surgical Clipping

Kim¹,

Baek

Jin

et al. 2018

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 65%

Coil Embolization in Patients with Recurrent Cerebral Aneurysms Who Previously Underwent Surgical Clipping

Kim¹,

Baek

Jin

et al. 2018

AJNR Am J Neuroradiol

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“…Twenty-five unique studies were included in the meta-analysis to evaluate outcomes of first retreatment for intracerebral aneurysms. 5,6,[9][10][11][12][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]…”

Section: Resultsmentioning

confidence: 99%

“…The NOS score did not vary greatly among the studies as most were retrospective case series and cohort studies that did not make comparison between the different treatment retreatment combinations, except for the ISAT. 5 Thirteen studies evaluated outcomes of surgery after coiling, 6,11,22,24,28,29,31,33,34,36,[38][39][40] 3 studies evaluated outcomes of coiling after coiling, 6,26,37 4 studies evaluated coiling after surgery, 9,27,32,35 3 studies evaluated surgery after surgery, 9,12,34 2 studied evaluated PED after coiling, 23,30 and 2 studies evaluated PED after PED (Medtronic Inc). 10,25 In studies that described outcomes of surgery after coiling, extrusion of coils and coil compaction were observed in 18.8% and 30.5% of cases, respectively.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…There is a great variety of initial treatment options which include: clipping, coiling, Pipeline Embolization Device (PED, C Chestnut Medical, Medtronic Inc, Dublin, Ireland), surgical (high-flow) bypass, wrapping, and trapping, Woven Endobridge (WEB, C Sequent Medical Inc, MicroVention Inc, Aliso Viejo, California) device, all of which can be used for retreatment. 6,[8][9][10][11][12] The aim of this meta-analysis was to evaluate the efficacy and safety of retreatment of intracranial aneurysms for all available treatment-retreatment combinations.…”

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confidence: 99%

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Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis

et al. 2018

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BACKGROUND Long-term results from the International Subarachnoid Hemorrhage Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) indicate considerably higher retreatment rates for aneurysms treated with coiling compared to clipping, but do not report the outcome of retreatment. OBJECTIVE To evaluate retreatment related outcomes. METHODS A meta-analysis in accordance with PRISMA guidelines was conducted using Medline search engines PubMed and EMBASE to identify articles describing outcomes after retreatment for intracranial aneurysms. Pooled prevalence rates for complete occlusion rate and mortality were calculated. Outcomes of different treatment and retreatment combinations were not compared because of indication bias. RESULTS Twenty-five articles that met the inclusion criteria were included in the meta-analysis. Surgery after coiling had a pooled complete occlusion rate of 91.2% (95% confidence interval [CI]: 87.0-94.1) and a pooled mortality rate of 5.6% (95% CI: 3.7-8.3). Coiling after coiling had a pooled complete occlusion rate of 51.3% (95% CI: 22.1-78.0) and a pooled mortality rate of 0.8% (95% CI: 0.15-3.7). Surgery after surgery did not provide a pooled estimate for complete occlusion as only one study was identified but had a pooled mortality rate of 5.9% (95% CI: 3.1-11.2). Coiling after surgery had a pooled complete occlusion rate of 56.1% (95% CI: 11.4-92.7) and a pooled mortality rate of 9.3% (95% CI: 4.1-19.9). All pooled incidence rates were produced using random-effect models. CONCLUSION Surgical retreatment was associated with a high complete occlusion rate but considerable mortality. Conversely, endovascular retreatment was associated with low mortality but also a low complete occlusion rate.

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“…Macrophage-based imaging may enable visualization of clinically crucial aspects, namely the formation and enlargement of CAs, as well as the localization of lesions that may rupture. CAs treated with radical surgery under craniotomy occasionally lead to re-enlargement and subarachnoid hemorrhage (Tsutsumi et al, 2001;Hokari et al, 2016). By visualizing the inflammatory response in CAs (i.e., macrophage localization), intraoperative detection of artery walls that require treatment may be possible in real-time, which would improve the provision of surgical support and curability of CAs.…”

Section: Discussionmentioning

confidence: 99%

Activatable Fluorescence Imaging of Macrophages in Cerebral Aneurysms Using Iron Oxide Nanoparticles Conjugated With Indocyanine Green

et al. 2020

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Background and Purpose: Chronic inflammation is involved in the formation and enlargement of cerebral aneurysms (CAs), with macrophages playing a key role in the process. The present study evaluated visualization of macrophages present in CAs using an activatable fluorescent probe (IONP-ICG) comprising an iron oxide nanoparticles (IONPs) conjugated with indocyanine green (ICG).Methods: IONP-ICG was intravenously administered to 15-week-old CA model rats (n = 8), and ex vivo near-infrared fluorescence (NIRF) imaging and histological assessment of exposed CAs and cerebral arteries were performed 48 h later. Similar evaluations were performed in the control group, which included CA model rats given IONPs or ICG (n = 8 each).Results: ICG-derived NIRF signals were detected in three IONP-ICG group rats but not in IONP or ICG control groups. Among the three rats that exhibited signals, NIRF signal accumulation was observed in the CA of two rats and at the site of hemodynamic stress in the left posterior cerebral artery in one rat. Histologically, NIRF signals correlated strongly with macrophage localization. A total of 13 CAs formed in the IONP-ICG group. The number of macrophages in the CA wall was significantly greater in the two CAs that exhibited NIRF signals compared to the remaining 11 CAs that did not (P = 0.037). Moreover, all 11 CAs that did not exhibit NIRF signals were iron-negative, while the two CAs that exhibited NIRF signals were both iron-positive (P = 0.013).Conclusion: NIRF imaging using an activatable IONP-ICG probe is feasible for detecting the macrophage-rich regions in CAs and the cerebral artery wall, which is considered an early lesion in the process of CA formation.

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Treatment of Recurrent Intracranial Aneurysms After Clipping: A Report of 23 Cases and a Review of the Literature

Cited by 18 publications

References 24 publications

Coil Embolization in Patients with Recurrent Cerebral Aneurysms Who Previously Underwent Surgical Clipping

Coil Embolization in Patients with Recurrent Cerebral Aneurysms Who Previously Underwent Surgical Clipping

Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis

Activatable Fluorescence Imaging of Macrophages in Cerebral Aneurysms Using Iron Oxide Nanoparticles Conjugated With Indocyanine Green

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