Late arterial erosion of a Crutchfield vascular clamp presenting with transient ischemic attacks: review of treatment options.

Crutchfield clamps were once widely used for proximal carotid artery ligation in the treatment of intracranial aneurysms and cavernous sinus fistulae. Consequently, there are a number of patients being followed who were treated with this device 10 to 15 years ago. The most important complication of this treatment modality in both the early and late postoperative period is thromboembolic phenomenon presenting as transient ischemic attacks, or a frank stroke. Because of the residual patient population with this device still in place, interval reports regarding the occurrence and treatment of late complications are important. We report a patient who underwent Crutchfield clamp application for control of a cavernous sinus fistula and had done well for 20 years when he developed transient ischemic attacks (TIA). Arteriography revealed a severe stenotic lesion (greater than 90%) in the common carotid artery with a patent internal carotid artery and no evidence of the previous fistula and an ulcerated plaque. At surgery, the pressure plate of the clamp had achieved an intraluminal position. The stenotic area was resected and an end to end anastomosis performed with complete resolution of symptoms after 18 months of follow-up. In this report we review the literature for complications of this device and discuss treatment options.