Aneurysm retreatment after Guglielmi detachable coil and nondetachable coil embolization: Report of nine cases and review of the literature

OBJECTIVE: Guglielmi detachable coil embolization of cerebral aneurysms is becoming increasingly used to manage certain intracranial lesions based on aneurysm geometry, patient condition, and patient and surgeon preferences, Aneurysm recurrences or incomplete initial treatments are not uncommon, mak ing repeat treatment necessary using either surgical or endovascular techni ques. METHODS: Between January 1993 and June 1998, 1025 cerebral aneurysms were m anaged by the authors at a single hospital. One hundred twenty-four of thes e lesions were treated using Guglielmi detachable coils, and one was manage d with nondetachable coils. During the follow-up period, eight patients who underwent embolization at our institution and one who underwent embolizati on elsewhere received repeat treatment. Five were approached surgically, an d four underwent re-embolization. All charts and films were reviewed retros pectively to determine patient outcome and clinical success. RESULTS: No patient in the subgroup of this clinical study suffered a perma nent complication from initial aneurysm coiling, no episodes of subsequent bleeding occurred, and no complications resulted from any subsequent therap ies. The anatomic results were excellent, and all aneurysms were totally or near totally obliterated. CONCLUSION: Subtotal initial coil embolization of aneurysms can be managed safely using a variety of surgical and endovascular techniques. Our approac h to this predicament, lessons we have learned, and a review of the literat ure are herein discussed.