Vascular Clamp-Assisted Clipping of Thick-Walled Giant Aneurysms

Navrátil, Ondřej; Lehečka, Martin; Lehto, Hanna; Dashti, Reza; Kivisaari, Riku; Niemelä, Mika; Hernesniemi, Juha

doi:10.1227/01.neu.0000330400.68015.88

Cited by 7 publications

(2 citation statements)

References 37 publications

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“…In the past, large, heavy clips, at times supplemented by booster clips, were used in attempts to close atheromatous aneurysm necks. 2,20,22,26 Recently, Navratil et al 27 reported their experience with crushing the neck of these aneurysms using various hemostats. Although this maneuver may be successful in select cases, the technique can result in embolic complications, dissection or occlusion of the parent artery, and even rupture of the aneurysm.…”

Section: Discussionmentioning

confidence: 99%

A Novel Aneurysm Clip Design for Atheromatous, Thrombotic, or Previously Coiled Lesions: Preliminary Experience With the “Compression Clip” in 6 Cases

Nussbaum

2010

Operative Neurosurgery

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Section: Discussionmentioning

confidence: 99%

A Novel Aneurysm Clip Design for Atheromatous, Thrombotic, or Previously Coiled Lesions: Preliminary Experience With the “Compression Clip” in 6 Cases

Nussbaum

2010

Operative Neurosurgery

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“…Wrapping of the aneurysm with cotton or other materials has been used as an alternative treatment for "unclippable" aneurysms, but this method is not considered durable. 7,13 The DeBakey vascular clamp-assisted clipping of giant aneurysms with a partially calcified atheromatic base has been described, 28 and this method can facilitate direct clipping in some rare cases. If previously performed coil embolization or stent placement has failed, clipping may be impossible with the endovascular material inside the vessel or aneurysm lumen.…”

Section: Treatment Principlesmentioning

confidence: 99%

Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree

Kivipelto

Niemelä

Meling

et al. 2014

JNS

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Object The object of this study was to describe the authors' institutional experience in the treatment of complex middle cerebral artery (MCA) aneurysms necessitating bypass and vessel sacrifice. Methods Cases in which patients with MCA aneurysms were treated with a combination of bypass and parent artery sacrifice were reviewed retrospectively. Results The authors identified 24 patients (mean age 46 years) who were treated with bypass and parent artery sacrifice. The aneurysms were located in the M1 segment in 7 patients, MCA bifurcation in 8, and more distally in 9. The mean aneurysm diameter was 30 mm (range 7–60 mm, median 26 mm). There were 8 saccular and 16 fusiform aneurysms. Twenty-one extracranial-intracranial and 4 intracranial-intracranial bypasses were performed. Partial or total trapping (only) of the parent artery was performed in 17 cases, trapping with resection of aneurysm in 3, and aneurysm clipping with sacrifice of an M2 branch in 4. The mean follow-up period was 27 months. The aneurysm obliteration rate was 100%. No recanalization of the aneurysms was detected during follow-up. There was 1 perioperative death (4% mortality rate) and 6 cerebrovascular accidents, causing permanent morbidity in 5 patients. The median modified Rankin Scale score of patients with an M1 aneurysm increased from 0 preoperatively to 2 at latest follow-up, while the score was unchanged in other patients. Most of the permanent deficits were associated with M1 aneurysms. Twenty-one patients (88%) had good outcome as defined by a Glasgow Outcome Scale score of 4 or 5. Conclusions Bypass in combination with parent vessel occlusion is a useful technique with acceptable frequencies of morbidity and mortality for complex MCA aneurysms when conventional surgical or endovascular techniques are not feasible. The location of the aneurysm should be considered when planning the type of bypass and the site of vessel occlusion. Flow alteration by partial trapping may be preferable to total trapping for the M1 aneurysms.

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Partially thrombosed intracranial aneurysms: symptoms, evolution, and therapeutic management

et al. 2010

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The natural history of PTIAs is different from other aneurysms. They most commonly present with progressive neurological symptoms due to mass effect. MRI properly diagnoses PTIAs and allows precise follow-up, more accurately than angiography because it detects prominent "abluminal" features indicating inflammation and neovascularization. Spontaneous thrombosis is part of the natural history of PTIAs and it should be taken in consideration when discussing the therapeutic management.

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Vascular Clamp-Assisted Clipping of Thick-Walled Giant Aneurysms

Abstract: The DeBakey vascular clamp is helpful in assisting direct clipping of thick-walled giant aneurysms with a partially calcified atheromatic base. Some practical features of this instrument require further refinement.

Cited by 7 publications

References 37 publications

A Novel Aneurysm Clip Design for Atheromatous, Thrombotic, or Previously Coiled Lesions: Preliminary Experience With the “Compression Clip” in 6 Cases

A Novel Aneurysm Clip Design for Atheromatous, Thrombotic, or Previously Coiled Lesions: Preliminary Experience With the “Compression Clip” in 6 Cases

Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree

Partially thrombosed intracranial aneurysms: symptoms, evolution, and therapeutic management

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