PMID- 26894462
OWN - NLM
STAT- MEDLINE
DCOM- 20180802
LR  - 20180802
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 125
IP  - 6
DP  - 2016 Dec
TI  - Clipping of previously coiled cerebral aneurysms: efficacy, safety, and
      predictors in a cohort of 111 patients.
PG  - 1337-1343
AB  - OBJECTIVE With the increasing number of aneurysms treated with endovascular
      coiling, more recurrences are being encountered. The aim of this study was to
      evaluate the efficacy and safety of microsurgical clipping in the treatment of
      recurrent, previously coiled cerebral aneurysms and to identify risk factors that
      can affect the outcomes of this procedure. METHODS One hundred eleven patients
      with recurrent aneurysms whose lesions were managed by surgical clipping between 
      January 2002 and October 2014 were identified. The rates of aneurysm occlusion,
      retreatment, complications, and good clinical outcome were retrospectively
      determined. Univariate and multivariate logistic regressions were performed to
      identify factors associated with these outcomes. RESULTS The mean patient age was
      50.5 years, the mean aneurysm size was 7 mm, and 97.3% of aneurysms were located 
      in the anterior circulation. The mean follow-up was 22 months. Complete aneurysm 
      occlusion, as assessed by intraoperative angiography, was achieved in 97.3% of
      aneurysms (108 of 111 patients). Among patients, 1.8% (2 of 111 patients) had a
      recurrence after clipping. Retreatment was required in 4.5% of patients (5 of
      111) after clipping. Major complications were observed in 8% of patients and
      mortality in 2.7%. Ninety percent of patients had a good clinical outcome.
      Aneurysm size (OR 1.4, 95% CI 1.08-1.7; p = 0.009) and location in the posterior 
      circulation were significantly associated with higher complications. All 3
      patients who had coil extraction experienced a postoperative stroke. Aneurysm
      size (OR 1.2, 95% CI 1.02-1.45; p = 0.025) and higher number of interventions
      prior to clipping (OR 5.3, 95% CI 1.3-21.4; p = 0.019) were significant
      predictors of poor outcome. An aneurysm size > 7 mm was a significant predictor
      of incomplete obliteration and retreatment (p = 0.018). CONCLUSIONS Surgical
      clipping is safe and effective in treating recurrent, previously coiled cerebral 
      aneurysms. Aneurysm size, location, and number of previous coiling procedures are
      important factors to consider in the management of these aneurysms.
FAU - Daou, Badih
AU  - Daou B
AD  - Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital
      for Neuroscience, Philadelphia, Pennsylvania; and.
FAU - Chalouhi, Nohra
AU  - Chalouhi N
AD  - Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital
      for Neuroscience, Philadelphia, Pennsylvania; and.
FAU - Starke, Robert M
AU  - Starke RM
AD  - University of Virginia, Charlottesville, Virginia.
FAU - Barros, Guilherme
AU  - Barros G
AD  - Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital
      for Neuroscience, Philadelphia, Pennsylvania; and.
FAU - Ya'qoub, Lina
AU  - Ya'qoub L
AD  - Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital
      for Neuroscience, Philadelphia, Pennsylvania; and.
FAU - Do, John
AU  - Do J
AD  - Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital
      for Neuroscience, Philadelphia, Pennsylvania; and.
FAU - Tjoumakaris, Stavropoula
AU  - Tjoumakaris S
AD  - Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital
      for Neuroscience, Philadelphia, Pennsylvania; and.
FAU - Rosenwasser, Robert H
AU  - Rosenwasser RH
AD  - Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital
      for Neuroscience, Philadelphia, Pennsylvania; and.
FAU - Jabbour, Pascal
AU  - Jabbour P
AD  - Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital
      for Neuroscience, Philadelphia, Pennsylvania; and.
LA  - eng
PT  - Journal Article
DEP - 20160219
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - AIM
SB  - IM
MH  - Embolization, Therapeutic
MH  - Endovascular Procedures/instrumentation/*methods
MH  - Female
MH  - Humans
MH  - Intracranial Aneurysm/*surgery
MH  - Male
MH  - Microsurgery
MH  - Middle Aged
MH  - Recurrence
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - *ACoA = anterior communicating artery
OT  - *PCoA = posterior communicating artery
OT  - *PED = Pipeline Embolization Device
OT  - *aneurysm
OT  - *clipping
OT  - *mRS = modified Rankin Scale
OT  - *previously coiled
OT  - *recurrence
OT  - *vascular disorders
EDAT- 2016/02/20 06:00
MHDA- 2018/08/03 06:00
CRDT- 2016/02/20 06:00
PHST- 2016/02/20 06:00 [pubmed]
PHST- 2018/08/03 06:00 [medline]
PHST- 2016/02/20 06:00 [entrez]
AID - 10.3171/2015.10.JNS151544 [doi]
PST - ppublish
SO  - J Neurosurg. 2016 Dec;125(6):1337-1343. doi: 10.3171/2015.10.JNS151544. Epub 2016
      Feb 19.