Selection and application of aneurysm clip in posterior communicating artery aneurysm clipping / 中国脑血管病杂志

ABSTRACT

Objective: To investigate the selection and application of aneurysm clips for microsurgical clipping of posterior communicating artery aneurysms (PCoAA). Methods: The clinical data of 46 patients with PCoAA whom underwent microsurgical clipping in Peking University First Hospital from January 2007 to June 2011 were analyzed retrospectively. The aneurysms were classified according to the relationship between the aneurysm neck and its parent artery. The locations of aneurysm necks, the types of aneurysm clip and the placement of aneurysm clips were analyzed. The patients were followed up by outpatient department examination, telephone inquiry and DSA for 4 months to 4 years. Results: Circled digit oneThe 46 patients with PCoAA were divided into 3 types according to the site of aneurysmal necks in parent artery; internal carotid artery (n = 19), PCoAA (n = 5) proper, and bifurcation (n = 22). Circled digit twoThe bent clip, straight clip, angled fenestrated clip, and bayonet-shaped clip were used in 37, 6, 2, and 1 patients, respectively. The clip length was 6-7 mm in 54.3% patients, and was 5-7 mm in 21.7% patients. In the PCoAA type and bifurcation type aneurysms, the clips were parallel to the direction of the vessels, while in the internal carotid type aneurysms were placed vertically the clips to the internal carotid artery in 13 patient, and parallel to the direction of the vessels in 6 patients. Circled digit threeThe postoperative follow-up showed that the patients did not have the clinical manifestations of aneurysm recurrence and rupture. Twelve patients were followed up with DSA, and it revealed that their aneurysm necks were occluded completely and no residual aneurysms seen. Conclusion: In the PCoAA clipping, confirming the location of aneurysm necks and identifying the relationship between the aneurysm and its surrounding vessels are critical for selecting and placing aneurysm clips. The first choice of bent aneurysm clip may improve the success rate for complete occlusion of PCoAA.