Retreatment of cerebral aneurysms after guglielmi detachable coil embolization

Abstract

Of 175 patients with 181 aneurysms initially treated with Guglielmi Detachable Coils (GDC), 25 were retreated. All retreatments except one were performed on previously ruptured aneurysms. Thirteen aneurysms were retreated because of recurrence, and 12 aneurysms were retreated to complete initial insufficient embolization. Sixteen patients underwent re-embolization and 9 patients were operated upon surgically. No complications related to the retreatment were experienced. We consider that repeat embolization should be attempted before considering surgical treatment in case that additional therapy is required. However, it is difficult to retreat aneurysms having wide necks. In regard to surgical clipping, aneurysms without a coil in the neck are easier to treat with primary clipping, whereas aneurysms with a coil mass in the neck are difficult to surgical clip. We have never used temporary clipping and coil extraction if the distance between the coil and the parent artery was wider than 2 mm. Emerging new embolic agents or devices and technical improvement might decrease the need for retreatment and increase long-term efficacy after endovascular treatment.

Figure 1

Left internal carotid injection demonstrates an anterior communicating artery aneurysm (A). The aneurysm was occluded using the GDC 10 system on day 1 (B). Follow-up angiogram performed three months later reveals aneurysmal recurrence (C). Surgical clipping was performed on the residual aneurysmal neck (D).

Figure 2

Left vertebral artery injection demonstrates left superior cerebellar artery aneurysm (A). The aneurysm was occluded using GDC10 coils on day 5 (B). Follow-up angiogram obtained 6 months later shows aneurysmal recurrence (C). Reembolization was performed. The additional GDC coils occluded the residual aneurysm (D).