Turkish Neurosurgery
Intentional Staged Clipping Following Previous Coil Embolization of Ruptured Aneurysm with a Branch Arising from the Neck: Technical Note
Torazawa Seiei1, Sato Daisuke1, Ogawa Shotaro1, Dofuku Shogo1, Sato Masayuki1, Ota Takahiro1
1Tokyo Metropolitan Tama Medical Center, Neurosurgery, Fuchu, Tokyo,
DOI: 10.5137/1019-5149.JTN.36970-21.3

Background: Small- or medium-sized aneurysms with a branch arising from the neck are challenging for endovascular treatment and can be better treated with clipping. In the acute phase of aneurysm rupture, however, the patient sometimes cannot undergo microsurgery. Herein, we present a substitute strategy for clipping: coil embolization of the ruptured aneurysm followed by intentional, staged clipping. Case Description: We treated five cases of ruptured intracranial aneurysms with branches arising from the neck. The mean aneurysm diameter was 4.4 mm. In the acute rupture phase, coiling was performed without adjunctive endovascular techniques with intentional preservation of the neck in all cases. To treat recurrence during follow-up, the previously coiled aneurysm was clipped, which did not occasion any complications. Postoperative imaging showed completely obliterated aneurysms and preserved branches. No rebleeding occurred during the interval between coiling and clipping, and no rebleeding or recurrence occurred after clipping. No treatment-related complications occurred after coiling and clipping. Conclusion: This two-stage strategy may be effective for hemostasis and branch preservation for small- and medium-sized ruptured aneurysms with a branch arising from the neck. This intentional two-stage strategy can be a substitute strategy for clipping in the acute rupture phase with an acceptable outcome if the patient cannot undergo clipping as the first-line treatment.

Corresponding author : Torazawa Seiei