初回手術から長期経過後出血した内頸動脈瘤のクリッピング術  [in Japanese] Reclipping of Ruptured Recurrent Internal Carotid Artery Aneurysms after Long-term Follow Up  [in Japanese]

The long-term outcomes of aneurysms occluded by clipping are unclear. The present study investigated 5 females aged from 45 to 72 years old (mean 63.6 years) admitted for treatment of recurrent subarachnoid hemorrhage (SAH) 7 to 19 years (mean 9.8 years) after clipping of internal carotid artery-posterior communicating artery (ICA-PCoA) aneurysms, which had caused SAH in 3 patients and were unruptured in 2 patients. Angiography delineated the well-developed PCoA in all patients. Clips had been applied to the aneurysm neck parallel to the ICA trunk at the initial surgery in 3 patients. An additional clip could be applied to the recurrent aneurysm without removal of the first clip in 2 patients, but the original clip had to be removed before reclipping in the other 3 patients. Adhesive materials and Bem-sheet used at the initial operation hindered dissection of the recurrent aneurysm from the surrounding arteries in 1 patient, resulting in infarction in the area of the PCoA perforating arteries. This study suggests that the method of clipping is very important for ICA-PCoA aneurysm, particularly the direction of clip application to the ICA trunk, and the avoidance of unnecessary or excessive wrapping of the residual neck. We recommend that neuroimaging follow-up of recurrent aneurysms in patients with a history of clipped aneurysm, especially ICA-PCoA aneurysm, be continued as long as possible.