Clipping of a ruptured anterior communicating artery aneurysm with right A1-A2 sectioning and reanastomosis

We showcase the microsurgical clipping of a previously coiled and ruptured anterior communicating artery aneurysm, done through a right-sided approach. Initial clipping with a fenestrated clip occluded the flow in the right A2. After temporary clipping of both A1 and A2 vessels, we cut the right A1 and A2, clipped the aneurysm with a straight clip while preserving the flow in the left A1 and A2 and then performed reanastomosis of the right A1-A2 in an end to end fashion. This strategy allowed for complete obliteration of the aneurysm while preserving the flow in all four vessels. © AANS, 2015.