Analysis of recurrence after clipping surgery in posterior communicating artery origin wide-necked aneurysm

초록

Purpose The treatment of recurrent aneurysms after previous clipping surgery is challenging even in the era of neurointervention. The authors experienced clipping and stent assisted coil embolization in the two cases respectively and discuss anatomical characteristics and technical issues in the recurrent aneurysms. Materials and Methods The authors present two cases of subarachnoid hemorrhage patients. The 69-year-old female who had underwent clipping of posterior communicating artery (PCoA) origin wide-necked aneurysm 5 years ago was transferred to emergency room with severe headache. During follow up periods, there had been no interval change of clip location or vascular structure. As bleeding focus was selected to be in end of permanent clip, the revision surgery was tried. The second case was the 71-year-old female who had experienced subarachnoid hemorrhage 11 years ago and underwent clipping surgery. The stent assisted coil embolization to cover the weak point was tried and successful. Results In the first case, reposition of previously applied permanent clip was not sufficient to cover the weak point, parallel clipping of fenestrated ones was done. Stent assisted coil embolization was performed in the second case. The patients discharged without neurological deficit. Conclusion The border of aneurysm and parent artery is unclear and dog ear not to compromise PCoA can be the cause of rebleedng after clipping surgery in PCoA origin wide-necked aneurysm. It can be treated with neurointervention or new surgical techniques.