Surgical indications and techniques for failed coiled aneurysms.

For two decades, endovascular coiling has revolutionized the treatment of intracranial aneurysms. However, as with all techniques, it has limitations and endovascular radiologists and neurosurgeons are regularly confronted by what we call "failed" coiled aneurysms. Failed coiled aneurysms can occur in different situations: a) presence of a significant remnant at the end of an endovascular procedure; b) recanalization of an initially satisfactory occlusion; and c) coil extrusion deemed too thrombogenic or threatening the blood flow in the parent vessel. We and other teams around the world have developed strategies to manage these difficult cases. Here, we compare our own experience with other reports in the literature