Turkish Neurosurgery 2022 , Vol 32 , Num 5
Intentional Staged Clipping Following Previous Coil Embolization of Ruptured Aneurysm with a Branch Arising from the Neck: Technical Note
Seiei TORAZAWA1,Daisuke SATO1,Shotaro OGAWA1,Shogo DOFUKU1,Masayuki SATO1,Takahiro OTA1
1Tokyo Metropolitan Tama Medical Center, Department of Neurosurgery, Fuchu, Japan DOI : 10.5137/1019-5149.JTN.36970-21.3 AIM: To 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. Keywords : Intracranial ruptured aneurysms, Clipping, Coil embolization, Endovascular treatment

Corresponding author : Seiei TORAZAWA, tora.xxx.001@gmail.com