From the Research
Raymond Roy Grade 2 aneurysm recurrence carries a significant risk of rupture that necessitates prompt attention and management to mitigate morbidity, mortality, and impact on quality of life. The risk associated with a Raymond Roy Grade 2 rupture is a critical concern due to the partial refilling of the aneurysm neck, which can lead to a higher probability of rebleeding compared to Grade 1, as indicated by studies such as 1. Key considerations in managing Raymond Roy Grade 2 aneurysm recurrences include:
- Close monitoring with follow-up cerebral angiography at 3-6 month intervals initially, then annually if stable, to assess for any changes in the aneurysm size or morphology.
- Retreatment is often advised, particularly for posterior circulation aneurysms, large recurrences, or those showing growth on sequential imaging, with options including endovascular coiling, stent-assisted coiling, flow diversion devices, or microsurgical clipping.
- Blood pressure control is crucial, aiming for systolic pressures below 140 mmHg, and avoiding activities that cause sudden increases in blood pressure. The most recent and highest quality study, 2, published in 2023, provides insights into the changes in modified Raymond-Roy classification occlusion classes and predictors of recurrence-free survival, highlighting the importance of close follow-up and timely intervention for aneurysms with higher recurrence risks. Given the potential for significant morbidity and mortality associated with aneurysmal rupture, a proactive approach to managing Raymond Roy Grade 2 recurrences is essential, prioritizing interventions that can reduce the risk of rupture and improve patient outcomes.