New semicircular clip for internal carotid artery aneurysms - Technical note

BACKGROUND Complete clipping of internal carotid artery (ICA) aneurysms without residual aneurysmal neck may conflict with preservation of the anterior choroidal artery, posterior communicating artery, or their branches. In addition, the neck of the aneurysm is often situated behind the ICA, as seen through the operative microscope. The blades of fenestrated clips can be inserted over the ICA, followed by reconstruction of the ICA wall to minimize the residual aneurysmal neck. However, the blades are out of the field of vision behind the ICA when they are closed, so that ICA branches or perforators may be clipped together with the aneurysmal neck. We have developed a semicircular clip to avoid this type of misclipping. METHODS AND RESULTS We have treated four patients with ruptured ICA aneurysms and two patients with unruptured ICA aneurysms with this semicircular clip. In all cases, the aneurysms were clipped without residual neck, and the ICA branches were preserved. CONCLUSION This instrumentation is especially useful in cases of ICA aneurysms protruding posteriorly or medially. (C) 1999 by Elsevier Science Inc.