Aneurysm Remnants After Coiling and Clipping: Considerations in Surgical and Endovascular Treatment Options

The clinical significance of remnants or recurrences of treated intracranial aneurysms is not a new concern for vascular neurosurgeons. However, in the endovascular era of aneurysm treatment, there has been more focus on this problem. It should be noted, first and foremost, that not all aneurysm remnants are created equally. Although the Raymond and Roy classification system¹ is widely used as a simple method to describe aneurysm remnants, the system does not have widespread clinical utility. For example, it does not indicate which patients require retreatment and which should be followed up with serial imaging. Diagrammatic classification systems fail to account for important clinical details such as rupture status, sidewall recurrences, follow-up stability, and patient comorbidities (Table). In the modern era of aneurysm treatment, remnants must be addressed in a comprehensive way on a case-by-case basis to ensure...