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Experience with coil embolization of previously clipped aneurysms presenting with rupture
  1. Alejandro M Spiotta1,2,
  2. Albert Schuette3,
  3. Ferdinand Hui2,
  4. Rishi Gupta4,
  5. Charles M Cawley3,
  6. Shaye I Moskowitz1,2
  1. 1Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
  4. 4Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Shaye I Moskowitz, Cerebrovascular Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA; moskows{at}


Introduction Endovascular coil embolization has an established role alongside microsurgical clipping in the treatment of aneurysms. We studied previously clipped aneurysms that presented as subarachnoid hemorrhage and were treated by coil embolization.

Methods A retrospective review was performed of two prospectively maintained databases from two institutions (Cleveland Clinic, Emory University) that spanned 12 years.

Results Seven patients were identified (mean age 56.9 years) who had previously undergone surgical clipping for aneurysm obliteration; six (86%) were previously ruptured. Patients presented with aneurysm rupture with a mean time of 11.5 years (range 4 months to 20 years) following surgical treatment. Aneurysm location included anterior communicating artery (n=4), posterior communicating artery (n=1), internal carotid artery terminus (n=1) and anterior choroidal (n=1). Three patients presented in Hunt and Hess (HH) grade 1, one in HH2, two in HH3 and one in HH4. Four of the patients underwent unassisted coil embolization while balloon assistance was employed in three. Angiographic results were as follows: complete occlusion (n=3; 42.9%) and residual neck (n=4; 57.1%). There were no intraprocedural complications.

Conclusion Aneurysm rupture following surgical obliteration is a rare event and may occur remote from the initial treatment. Endovascular embolization with or without balloon assistance can be safely employed in cases of aneurysm recurrence rupture following surgical treatment with satisfactory angiographic treatment.

  • Coil
  • coil embolization
  • recurrent aneurysm
  • surgical clipping
  • results

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  • Competing interests None.

  • Ethics approval Ethics Committee Approval The database is prospectively collected and approved by the Institutional Review Board of the Cleveland Clinic, Cleveland, Ohio.

  • Provenance and peer review Not commissioned; externally peer reviewed.