Intracranial post‑clipping residual or recurrent aneurysms: Current status and treatment options (Review)

Piao,Jianmin; Luan,Tengfei; Qu,Lai; Yu,Jinlu

doi:10.3892/mi.2021.1

Intracranial post‑clipping residual or recurrent aneurysms: Current status and treatment options (Review)

Authors:
- Jianmin Piao
- Tengfei Luan
- Lai Qu
- Jinlu Yu
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Affiliations: Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China, Department of Intensive Care, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
Published online on: April 12, 2021 https://doi.org/10.3892/mi.2021.1
Article Number: 1
Copyright: © Piao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Following the clipping of intracranial aneurysms, post‑clipping residual or recurrent aneurysms (PCRRAs) can occur. In recent years, the incidence of PCRRAs has increased due to a prolonged follow‑up period and advanced imaging techniques. However, several aspects of intracranial PCRRAs remain unclear. Therefore, the present study performed an in‑depth review of the literature on PCRRAs. Herein, a summary of PCRRAs that can be divided into the following two categories is presented: i) Those occurring after the incomplete clipping of an aneurysm, where the residual aneurysm regrows into a PCRRA; and ii) those occurring after the complete clipping of an aneurysm, in which a de novo aneurysm occurs at the original aneurysm site. Currently, digital subtracted angiography remains the gold standard for the imaging diagnosis of PCRRAs as it can eliminate metallic clip artifacts. Intracranial symptomatic PCRRAs should be actively treated, particularly those that have ruptured. A number of methods are currently available for the treatment of intracranial PCRRAs; these mainly include re‑clipping, endovascular treatment (EVT) and bypass surgery. Currently, re‑clipping remains the most effective method used to treat PCRRAs; however, it is a very difficult procedure to perform. EVT can also be used to treat intracranial PCRRAs. EVT methods include coiling (stent‑ or balloon‑assisted) and flow‑diverting stents (or coiling‑assisted). Bypass surgery can be selected for difficult‑to‑treat, complex PCRRAs. On the whole, following appropriate treatment, the majority of intracranial PCRRAs achieve a high occlusion rate and a good prognosis.

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