TY - JOUR
T1 - Balloon-assisted clipping of a large paraclinoidal aneurysm
T2 - A salvage procedure
AU - Elhammady, Mohamed Samy
AU - Nakaji, Peter
AU - Farhat, Hamad
AU - Morcos, Jacques J.
AU - Aziz-Sultan, Mohammad Ali
PY - 2009/12
Y1 - 2009/12
N2 - OBJECTIVE: Surgical clipping and parent vessel reconstruction of wide-neck paraclinoid aneurysms can be very challenging. We report a case of a ruptured paraclinoid aneurysm which failed standard clipping techniques. We were able to reconstruct this aneurysm while providing proximal and distal control using an adjuvant endovascular balloon. CLINICAL PRESENTATION: We report the case of a 45-year-old woman presenting with a ruptured large paraclinoidal aneurysm, which involved a significant portion of the internal carotid artery wall. INTERVENTION: Repeated attempts at fenestrated clip placement resulted in slipping of the clip and occlusion of the parent artery. Ultimately, the aneurysm ruptured at the neck, and, despite trapping and direct aneurysmal suction decompression, significant bleeding was encountered. The bleeding point was packed, and, subsequently, endovascular access was obtained. A balloon was navigated and then inflated across the neck of the aneurysm using C-arm fluoroscopic guidance. The aneurysm was successfully clipped, and intraoperative angiography demonstrated no parent vessel stenosis. CONCLUSION: This case demonstrates a salvage procedure in the event of intraoperative rupture and inadequate interruption of local blood flow. Balloon inflation resulted in adequate hemostasis and provided intraluminal support for optimal clip placement while preserving the parent artery.
AB - OBJECTIVE: Surgical clipping and parent vessel reconstruction of wide-neck paraclinoid aneurysms can be very challenging. We report a case of a ruptured paraclinoid aneurysm which failed standard clipping techniques. We were able to reconstruct this aneurysm while providing proximal and distal control using an adjuvant endovascular balloon. CLINICAL PRESENTATION: We report the case of a 45-year-old woman presenting with a ruptured large paraclinoidal aneurysm, which involved a significant portion of the internal carotid artery wall. INTERVENTION: Repeated attempts at fenestrated clip placement resulted in slipping of the clip and occlusion of the parent artery. Ultimately, the aneurysm ruptured at the neck, and, despite trapping and direct aneurysmal suction decompression, significant bleeding was encountered. The bleeding point was packed, and, subsequently, endovascular access was obtained. A balloon was navigated and then inflated across the neck of the aneurysm using C-arm fluoroscopic guidance. The aneurysm was successfully clipped, and intraoperative angiography demonstrated no parent vessel stenosis. CONCLUSION: This case demonstrates a salvage procedure in the event of intraoperative rupture and inadequate interruption of local blood flow. Balloon inflation resulted in adequate hemostasis and provided intraluminal support for optimal clip placement while preserving the parent artery.
KW - Balloon-assisted clipping
KW - Intraoperative rupture
KW - Paraclinoidal aneurysm
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UR - http://www.scopus.com/inward/citedby.url?scp=74349128759&partnerID=8YFLogxK
U2 - 10.1227/01.NEU.0000357324.86905.DC
DO - 10.1227/01.NEU.0000357324.86905.DC
M3 - Article
C2 - 19934944
AN - SCOPUS:74349128759
VL - 65
SP - E1210-E1211
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 6
ER -