(Stroke. 2001;32:1191.)
© 2001 American Heart Association, Inc.
Original Contributions |
Risk of Aneurysm Recurrence in Patients With Clipped Cerebral Aneurysms
Results of Long-Term Follow-Up Angiography
From the Department of Neurosurgery (K.T.), Aizu Chuou Hospital, Aizuwakamatsu, Japan; Department of Neurosurgery (M.U.), Toranomon Hospital, Fukushima, Japan; and Department of Neurosurgery (K.T., K.U., A.M., T.K.), University of Tokyo Hospital, Tokyo, Japan.
Correspondence to Kazuo Tsutsumi, MD, Department of Neurosurgery, Aizu Chuo Hospital, Tsuruga 1-1, Aizuwakamatsu, Fukushima 965, Japan. E-mail haku2111{at}akina.ne.jp
Background and Purpose—With many patients living long after microsurgical aneurysm clipping for subarachnoid hemorrhage (SAH) and with the evolution of intravascular procedures as less invasive alternatives, knowledge of the long-term results of clipping is becoming important.
Methods—Of 412 patients who underwent clipping of ruptured or unruptured cerebral aneurysms at our institution between 1976 and 1994 and who survived >3 years after surgery, 225 patients who were in good general condition and younger than 80 years were offered follow-up angiography to detect newly formed aneurysms. Of the 225, 80 patients (35.6%) agreed to undergo angiography. In addition, 32 patients underwent angiography for new medical indications other than SAH. Therefore, 112 patients underwent angiography, representing a total of 140 clipped aneurysms.
Results—The mean interval from surgery was 9.3 years for all patients and 9.0 years for the clipped aneurysms (range 3 to 21 years). Four aneurysm regrowths were detected of the 140 (2.9%) clipped aneurysms, representing 3 of 125 completely clipped aneurysms, 1 of 14 incompletely clipped aneurysms, and 0 of 1 aneurysm not studied with postoperative angiography. De novo aneurysms were detected in 9 of 112 (8.0%) patients. The annual rate of de novo aneurysm formation was 0.89%.
Conclusions—This study shows that the annual rate of de novo aneurysm formation is relatively high (0.89%) and that the cumulative risk becomes significant after 9 years. In consideration of the fatality rate of SAH, follow-up angiography may be indicated for patients with clipped aneurysms 9 to 10 years after surgery.
Key Words: follow-up study • cerebral aneurysm • cerebral angiography • subarachnoid hemorrhage
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