Long-term clinical and angiographic outcomes of wrap-clipping strategies for unclippable cerebral aneurysms

To evaluate the efficacy and stability of the wrap-clipping methods as a reconstructive strategy in the treatment of unclippable cerebral aneurysms. Twenty four patients who had undergone wrap-clipping microsurgery were retrospectively reviewed. Type and morphology of the treated aneurysm, utilized...

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Bibliographic Details
Published in:Yonsei medical journal 2014-03, Vol.55 (2), p.401-409
Main Authors: Kim, Yong Bae, Hong, Chang Ki, Chung, Joonho, Joo, Jin Yang, Huh, Seung-Kon
Format: Article
Language:English
Subjects:
Adult
Aged
Carotid Artery, Internal - surgery
Cerebral Angiography
Female
Follow-Up Studies
Humans
Intracranial Aneurysm - surgery
Male
Microsurgery - methods
Middle Aged
Original
Retrospective Studies
Treatment Outcome
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Summary:To evaluate the efficacy and stability of the wrap-clipping methods as a reconstructive strategy in the treatment of unclippable cerebral aneurysms. Twenty four patients who had undergone wrap-clipping microsurgery were retrospectively reviewed. Type and morphology of the treated aneurysm, utilized technique for wrap-clip procedure, and clinical outcome with angiographic results at their last follow-up were evaluated. Of 24 patients, eleven patients had internal carotid artery (ICA) blister-like aneurysms, three had dissecting type aneurysms, and ten had fusiform aneurysms. The follow-up period for the late clinical and angiographic results ranged from 10 to 75 months (mean 35 months). Wrap-clipping was performed in eleven, wrap-holding clipping was in ten, and combination of wrap-clip and wrap-holding clip was in three cases. At the last angiographic follow-up study, twelve aneurysms (50%) were found to have completely healed, and nine aneurysms (38%) were at least stable. However, wrap-holding clip for the elongated blister type of ICA aneurysm was found failed, leading to fatal rebleeding in one case, and two cases of combination of wrap-clip-wrap-holding clip revealed delayed branch occlusion and marked regrowing, respectively. Wrap-clipping strategy could be an easy and safe alternative for unclippable aneurysms. The wrapped aneurysm mostly disappeared, or at least remained stationary, after a long-term period. However, surgeons should be aware of that the wrapped aneurysm might become worse. Therefore, follow-up surveillance for an extended period should be mandatory.
ISSN:0513-5796
1976-2437
DOI:10.3349/ymj.2014.55.2.401