Pipeline Embolization Device for Recurrent Cerebral Aneurysms after Microsurgical Clipping

Abstract

Microsurgical clipping is regarded as the most durable treatment for cerebral aneurysms. Aneurysm recurrence after clipping is uncommon and is associated with an increased risk of rupture. Reoperation for recurrent cerebral aneurysms is particularly challenging because of adhesions and scaring, and it carries a higher rate of morbidity and mortality. Pipeline embolization as a treatment option for recurrent aneurysms has rarely been reported. A retrospective analysis of patients who underwent Pipeline Embolization Device (PED) placement for recurrent aneurysms after clipping at two major academic institutions in the United States was performed. Seven patients were identified. The median time between initial clipping and diagnosis of recurrence was 13 years (range, 5-20 years). No morbidity or mortality was associated with PED placement. Complete occlusion was achieved in all patients with imaging follow-up. A history of prior clipping did not affect PED placement or outcome. PED for recurrent aneurysms after clipping may be a feasible alternative to reoperation. In our experience, treatment with PED for these aneurysms is safe and efficacious.