Re-recurrence of intracranial aneurysm with proximal vascular stenosis after primary clipping and secondary endovascular embolization: A case report and literature review.

BACKGROUND: It was known that a small number of patients could have intracranial aneurysm recurrences after either surgical clipping or endovascular embolization treatment. However, early recurrence within one month after the treatment and re-recurrence was rarely reported before.

CASE PRESENTATION: We reported a 46-year-old male patient with a medical history of smoking and hypertension who was non-compliant with the treatments. He presented to the hospital due to right extremity paralysis and aphasia, and was found to have a ruptured middle cerebral artery aneurysm. Aneurysm was successfully treated by surgical clipping. Within one month after the treatment, the patient had a recurrent aneurysm at the same location and intracranial hemorrhage. The recurrent aneurysm was treated by endovascular embolization. However, during the follow-up visit 8 months after the treatment, angiography showed the aneurysm recurrence with proximal vascular stenosis.

CONCLUSION: Re-recurrence of intracranial aneurysm could happen after initial successful treatment with surgical clipping and endovascular embolization. In addition to patient's medical history and characteristics of the aneurysm, local vascular stenosis might also contribute to its recurrence. Close post-operative follow-up is required for these patients.