Diagnosis And Retreatment For Post-embolization Recurrent Intracranial Aneurysms

Objective: To retrospectively analyze the clinical data of patients with post-embolization recurrent intracranial aneurysms,and discuss the retreatment strategies and technics.Methods: From January 2015 to November 2017,35 patients with post-embolization recurrent intracranial aneurysms received further microsurgical clipping(n=14)or endovasuclar embolization(n=21)in our department.It was divided into microsurgical clipping group(n = 14)and interventional embolization group(n = 21).With respect to the location of the aneurysm,all the microsurgically-clipped aneurysms(14/14)are located within the anterior cerebral circulation,while the anterior circulation aneurysm accounted for 85.7%(18/21) and the posterior circulation aneurysm for14.3%(3/21)in patients recieved endovascular retreatment.Result: All post-embolization recurrent intracranial aneurysms were satisfactorily obliterated after retreatment.For aneurysms retreated with endovascular embolisation,90.4%(19/21)can be graded as grade I aneurysms using the Modified Raymond-Roy classification(MRRC)and 9.6%(2/21)be the grade Ⅱ,while those with microsugical clipping,92.9%(13/14)are the MRRC grade I and 7.1%(1/14)are the MRRC grade Ⅱ.There was no significant difference between the two groups(P > 0.05).Clinical prognosis,All endovascularly-retreating patients((21/21)had a Glasscow Outcome Score(GOS)of 5,and 92.9%(13/14)of patients after microsurgical clipping had a GOS of 5 except for one patient(1/14)with GOS of 3.There was no significant difference between the two groups(P > 0.05).Conclusion:When post-embolization recurrent intracranial aneurysms need to be retreated,for anterior circulation aneurysms,both endovascular embolization and microsurgical clipping can achieve ideal therapeutic effects.However,with respect to posterior circulation aneurysms,interventional embolization is preferred but microsurgical clipping can be an alternative,and under certain circumstance a combination of two techniques can be a safe and effective method.