Risk of intracranial aneurysm recurrence after microsurgical clipping based on 3D digital subtraction angiography.

Marbacher, Serge; Grüter, Basil Erwin; Wanderer, Stefan; Andereggen, Lukas; Cattaneo, Marco; Trost, Patricia; Gruber, Philipp; Diepers, Michael; Remonda, Luca; Steiger, Hans-Jakob (2022). Risk of intracranial aneurysm recurrence after microsurgical clipping based on 3D digital subtraction angiography. (In Press). Journal of neurosurgery, pp. 1-7. American Association of Neurological Surgeons 10.3171/2022.5.JNS22424

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Current knowledge of recurrence rates after intracranial aneurysm (IA) surgery relies on 2D digital subtraction angiography (DSA), which fails to detect more than 75% of small aneurysm remnants. Accordingly, the discrimination between recurrence and growth of a remnant remains challenging, and actual assessment of recurrence risk of clipped IAs could be inaccurate. The authors report, for the first time, 3D-DSA-based long-term durability and risk factor data of IA recurrence and remnant growth after microsurgical clipping.


Prospectively collected data for 305 patients, with a total of 329 clipped IAs that underwent baseline 3D-DSA, were evaluated. The incidence of recurrent IA was described by Kaplan-Meier curves. Risk factors for IA recurrence were analyzed by multivariable Cox proportional hazards and logistic regression models.


The overall observed proportion of IA recurrence after clipping was 2.7% (9 of 329 IAs) at a mean follow-up of 46 months (0.7% per year). While completely obliterated IAs did not recur during follow-up, incompletely clipped aneurysms (76 of 329) demonstrated remnant growth in 11.8% (3.4% per year). Young age and large initial IA size significantly increased the risk of IA recurrence.


The findings support those in previous studies that hypothesized that completely clipped IAs have an extremely low risk of recurrence. Conversely, the results highlight the significant risk posed by incompletely clipped IAs. Young patients with initial large IAs and incomplete obliteration have an especially high risk for IA recurrence and therefore should be monitored more closely.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Marbacher, Serge; Wanderer, Stefan and Andereggen, Lukas


600 Technology > 610 Medicine & health




American Association of Neurological Surgeons




Pubmed Import

Date Deposited:

02 Aug 2022 13:12

Last Modified:

05 Dec 2022 16:22

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

3D digital subtraction angiography aneurysm recurrence aneurysm remnant clipping intracranial aneurysm vascular disorders





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