National Brain Aneurysm Center, St. Joseph's Hospital, St. Paul, Minnesota, USA.
Neurosurgery. 2010 Dec;67(2 Suppl Operative):333-41. doi: 10.1227/NEU.0b013e3181f7451b.
Large and giant lesions often have thicker, atheromatous walls as well as intra-aneurysmal thrombus that combine to prevent traditional clips from closing properly in some cases.
To report the development and use of a novel clip design specifically tailored to treat atheromatous, thrombotic, or previously coiled aneurysms.
We retrospectively reviewed the records of 6 patients with complex aneurysms not amenable to simple neck clipping and not considered appropriate for endovascular therapy who were treated using a novel "compression" clip design. We describe the development and use of a novel aneurysm clip design with blades that are not opposed at rest to allow direct clipping of atheromatous, thrombotic, and previously coiled aneurysms.
Four patients had recurrent, previously coiled aneurysms; one of these also had a large thrombotic component. Two patients had complex lesions with heavy atheroma involving a portion of their aneurysms. There were no complications related to the use of the clip, and all patients did well without neurological complications. In every case, the clip allowed straightforward obliteration of the aneurysm without the need for temporary vascular occlusion, aneurysmorrhaphy, or removal of an intra-aneurysmal coil mass. All patients underwent intraoperative angiography to confirm obliteration of the aneurysm with preservation of the normal vasculature.
Atheromatous, thrombotic, and previously coiled aneurysms may not be treatable with simple neck clipping and may not be curable with endovascular therapy. For such cases, we designed a novel "compression" clip that has been used safely and successfully in our experience with good short-term follow-up.
大动脉瘤和巨大动脉瘤的瘤壁往往较厚，呈粥样硬化，瘤腔内有血栓形成，这些因素结合起来导致在某些情况下传统夹闭无法完全闭合。
报告一种新型夹闭装置的设计和应用，该夹闭装置专门用于治疗粥样硬化、血栓形成或先前弹簧圈填塞的动脉瘤。
我们回顾性分析了 6 例复杂动脉瘤患者的病历资料，这些患者的动脉瘤不适宜单纯颈夹闭，也不适合血管内治疗，采用了一种新型“压缩”夹闭装置进行治疗。我们描述了一种新型动脉瘤夹闭装置的设计和应用，该夹闭装置的钳叶在静止时不相对，可直接夹闭粥样硬化、血栓形成和先前弹簧圈填塞的动脉瘤。
4 例患者为复发性、先前弹簧圈填塞的动脉瘤，其中 1 例瘤腔内有大量血栓形成。2 例患者的病变复杂，瘤颈部有大量粥样硬化斑块。使用夹闭装置无相关并发症，所有患者均恢复良好，无神经功能障碍。在所有病例中，夹闭装置可直接闭塞动脉瘤，无需临时血管阻断、动脉瘤缝合或取出瘤腔内的弹簧圈。所有患者均在术中进行血管造影，以确认动脉瘤闭塞，正常血管得到保留。
粥样硬化、血栓形成和先前弹簧圈填塞的动脉瘤可能无法通过单纯颈夹闭治疗，也可能无法通过血管内治疗治愈。对于这些病例，我们设计了一种新型的“压缩”夹闭装置，在我们的经验中，该夹闭装置安全且成功地应用，短期随访结果良好。
