Ferroli P, Acerbi F, Tringali G, Polvani G, Parati E, Broggi G
Department of Neurosurgery, Fondazione Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
Acta Neurochir (Wien). 2009 Aug;151(8):969-76; discussion 976. doi: 10.1007/s00701-009-0365-7. Epub 2009 May 15.
To report experience on the use of self-closing nitinol U-Clips for different types of intracranial arterial microanastomosis.
We treated 7 patients (3 females and 4 males, age ranging from 25 to 68 yo) admitted from November 2005 to January 2008 to the Neurological Institute C. Besta of Milan. One patient had cerebral hypoperfusion and the others a complex intracranial aneurysm. In each patient a bypass procedure was completed by using self-closing Nitinol U-Clips for intracranial arterial microanastomoses.
The total time of temporary occlusion was 15.71 +/- 4.386 min. Bypass patency was confirmed intraoperatively by near-infrared indocyanine green videoangiography and microdoppler in each patient. No spasm of the graft was encountered and immediate post-operative bypass patency was confirmed in 6/7 patients. The graft thrombosed in 1 patient with antiphospholipid syndrome. 1 patient died from a massive Subarachnoid Hemorrhage due to rupture of an aneurysm while waiting for an endovascular procedure. In the 5 patients at the last follow-up, long-term patency of the bypass was confirmed and no neurological deficits occurred related to the procedure.
This is the first report of the use of U-Clips for intracranial microanastomosis. Our data indicated that it is a safe technique, reduces the time taken to perform an anastomosis and the risk of an ischemic complication. Further studies of the longer-term patency of bypass as performed with U-Clips are required.
报告使用自闭合镍钛合金U形夹进行不同类型颅内动脉微血管吻合术的经验。
我们对2005年11月至2008年1月间收治于米兰C. 贝斯塔神经研究所的7例患者（3例女性，4例男性，年龄在25至68岁之间）进行了治疗。1例患者存在脑灌注不足，其他患者患有复杂颅内动脉瘤。在每例患者中，均使用自闭合镍钛合金U形夹进行颅内动脉微血管吻合术完成搭桥手术。
临时阻断的总时间为15.71±4.386分钟。术中通过近红外吲哚菁绿视频血管造影和微型多普勒在每例患者中确认搭桥通畅。未遇到移植物痉挛，6/7例患者术后即刻搭桥通畅得到确认。1例抗磷脂综合征患者的移植物发生血栓形成。1例患者在等待血管内治疗过程中因动脉瘤破裂死于大量蛛网膜下腔出血。在最后一次随访的5例患者中，确认了搭桥的长期通畅，且未发生与手术相关的神经功能缺损。
这是关于使用U形夹进行颅内微血管吻合术的首次报告。我们的数据表明这是一种安全的技术，可减少吻合所需时间以及缺血性并发症的风险。需要对使用U形夹进行搭桥的长期通畅情况进行进一步研究。
