Why might another treatment be recommended for an aneurysm that has already been treated?
Why another treatment might be recommended for an aneurysm that has already been treated: residual aneurysm, recanalization, comparison with previous studies, and reassessment.
By Dr. Martin Roberto Casas MartínezNov 4, 20265 min read
In this article
Summary: Another treatment may be recommended when follow-up imaging shows that part of the aneurysm is still filling with blood (a residual) or has filled again over time (recanalization), which can happen especially after treatment with coils. This does not always mean there was an error or that another procedure is necessary: the care team compares the findings with previous imaging and assesses whether they change your risk.
After a brain aneurysm is repaired, either with a clip or from inside the artery, it is common to have repeat imaging. If you are told that another treatment may be recommended for the aneurysm that has already been treated (retreatment), it is natural to feel concerned. Understanding what was found and how it compares with earlier findings can help you take part in the decision.
What does it mean to have a residual or recanalization?
A residual is a part of the aneurysm or its base that continues to receive blood after the first treatment. Recanalization occurs when, over time, blood begins to flow again into an aneurysm that had appeared closed.
During embolization, coils (in English coils) are placed. RadiologyInfo describes them as soft platinum wire thinner than a hair, used to fill the aneurysm from the inside. MedlinePlus warns that an aneurysm treated with coils may grow again, and Mayo Clinic explains that if it recurs, the procedure may need to be repeated. With clipping (a metal clip at the base of the aneurysm), Mayo Clinic notes that it generally does not recur.
Does this mean the first treatment failed?
Not necessarily. A residual portion or recanalization of the aneurysm is a known possibility with these treatments, which is why follow-up imaging is performed. It also does not mean that another procedure is always necessary.
Sometimes the first treatment closes the aneurysm as much as possible without excessively increasing the risks at that time, especially in an emergency or when the aneurysm has a complex shape. Mayo Clinic notes that you may need follow-up imaging to make sure the aneurysm has not returned. A small, stable residual may simply be monitored.
Why compare with earlier imaging?
Because a single image cannot show whether a finding is new, growing, or stable. Comparing it with the imaging done immediately after treatment and with later follow-up scans shows the trend, which matters more than any one image.
RadiologyInfo explains that radiologists include comparisons with relevant prior imaging in their reports; keep the discs and reports from all your follow-up visits. This comparison also helps distinguish a residual from the same aneurysm from a separate aneurysm in a different artery, since MedlinePlus reminds us that a person can have more than one.
What does a new assessment involve?
The goal is to clarify whether the finding increases the risk of bleeding, whether continued monitoring or another treatment is advisable, and, if so, which technique to use. Your current health is also reviewed, as it may have changed since the first treatment.
Factors include the size of the residual, whether it changed between scans, whether the aneurysm bled before, and your overall health. Options may include another embolization with coils or devices such as a stent (a metal mesh that supports the coils), clip surgery, or monitoring. Mayo Clinic warns that endovascular treatment carries risks, such as bleeding in the brain or loss of blood flow.
What symptoms should not wait until your appointment?
A sudden, severe headache, stiff neck, nausea with vomiting, loss of consciousness, weakness, or sudden problems with vision or speech should not wait until your appointment: call 911.
MedlinePlus discharge instructions after aneurysm repair list these symptoms among the reasons to seek medical attention. Having an aneurysm that has already been treated does not rule them out.
Frequently asked questions
Would the new treatment have to be the same as the first one?
Not necessarily. Depending on the shape of the residual and the previous treatment, the care team may recommend another embolization using a different technique, clip surgery, or continued monitoring. Each option has its own risks, which should be explained to you before you decide.
Can an aneurysm treated with a clip come back, too?
This is less common. Mayo Clinic explains that, in general, aneurysms treated with clipping do not come back. Even so, other aneurysms can occur in other arteries, so the care team will decide whether you need follow-up imaging.
Is it a good idea to get a second opinion before having it treated again?
It may be helpful if the situation is not urgent and you still have questions. Bring all your imaging, including scans from the first treatment, so the comparison is complete. A second opinion should not delay care if you have warning symptoms.
What should you ask before deciding?
If you have a sudden, severe headache, loss of consciousness, or sudden weakness, call 911 first. For your appointment, bring the imaging and reports from your first treatment and follow-up visits, and ask:
- •Is what we see a residual, recanalization, or a new aneurysm, and how do you know?
- •Has it changed compared with my earlier imaging, and what risk does that involve?
- •What happens if we continue monitoring, and what are the risks of retreatment with each technique?
To prepare your questions, you can learn more about flow diverter treatment and treatment with coils.
For non-urgent questions or to request an individual assessment, you can contact the office.
Informational notice: This content is for informational purposes and does not replace a medical consultation or constitute a diagnosis.
References
- •
- •
- •
- •
- •
