The efficiency of the new Yasargil titanium fenestrated mini-clips for ideal clipping of a cerebral aneurysm

Abstract

Background:The fenestrated clip is sometimes useful in limited approach angle and narrow working space. However, before the development of the new Yasargil titanium fenestrated mini-clip, the only variations of fenestrated clips were those of larger sizes. And those larger clips have a problem of the triangle-shaped gap at the proximal end of the blade. The authors describe the efficiency, limitations and surgical technique of using the Yasargil titanium fenestrated mini-clip.Methods:Fifty-nine cases of aneurysms were treated using these mini-clips. Aneurysm location, size and dome neck ratio, mean follow-up period, neck remnant, and recurrence rate were also analyzed. Among these cases, we present eight characteristic cases, including a case with aneurysm recurrence, and we review the problems associated with the triangle-shaped gap at the proximal end of the clip.Results:The average size of the aneurysms was 5.57 mm, and the dome neck ratio was >2.0 in 1.69%, >1.5 in 11.8%, >1.2 in 35.6%, and <1.2 in 50.8% of cases. The mean follow-up period for the 59 cases was 5.5 months (range, 0.5–16 months). Angiographic recurrence of the treated portion occurred in 1 case (1.7%), including an aneurysm in the basilar artery tip aneurysm.Conclusion:The availability of the Yasargil titanium fenestrated mini-clip increases the options for clipping to minimize the remnant of the clipped aneurysm. However, there is still concern over the triangular space at the base of the blade, especially when treating an aneurysm with a thin vessel wall. Therefore, modification of the clipping technique is sometimes needed.

Utility of crankshaft clips for middle cerebral artery aneurysms: A single-center experience of 150 cases

“…Despite the recent dramatic improvement in endovascular treatment,[ 4 8 17 ] clipping surgery is still indispensable for MCA aneurysms owing to the complicated structure of the aneurysms,[ 5 22 23 ] and multiple clipping is a well-accepted treatment strategy. [ 1 12 20 21 ] The bifurcation type of MCA aneurysm has a deeply curved closure line, which requires additional clips for the dog-ear remnant part. [ 10 11 ] In such cases, bipolar coagulation[ 13 18 ] and combination clip techniques[ 1 12 20 21 ] can be considered.…”

“…[ 1 12 20 21 ] The bifurcation type of MCA aneurysm has a deeply curved closure line, which requires additional clips for the dog-ear remnant part. [ 10 11 ] In such cases, bipolar coagulation[ 13 18 ] and combination clip techniques[ 1 12 20 21 ] can be considered. However, bipolar coagulation may cause premature rupture, and multiple clipping techniques use tandem clipping or fenestrated clips and are rather complex.…”

“…Multiple clipping has been a widely used technique for complicated MCA aneurysms because the ideal closure line can be achieved with it. [ 1 12 20 21 ] However, it is a more complicated technique and requires more experience. Reapplication of the first clip is often necessary, which might cause premature rupture.…”

“…This ideal closure line of an aneurysm, defined as the line emerging at clipping, is a relatively new concept, first described by Ishikawa in 2007. [ 10 11 ] To make an ideal closure line, clipping with multiple clips has been widely used;[ 1 12 20 21 ] however, limitations on the approach angle and working space prevent some aneurysm clips from achieving an ideal closure line, in particular, for aneurysms in deep locations.…”

Clipping treatment of posterior communicating artery aneurysms associated with arteriosclerosis and calcification: A single center study of 136�cases

“…There are many techniques for clipping PCoA aneurysms, with >100 types of intracranial aneurysm clips available (25). Among them, fenestrated clips for PCoA aneurysm clipping are occasionally used (26). The use of straight, curved or angled clips for clipping aneurysm necks and parent arteries with arteriosclerosis and calcification can easily cause intraoperative rupture and hemorrhage due to the low flexibility of these structures (27).…”