Long-Term Clinical and Angiographic Outcomes of Wrap- Clipping Strategies for Unclippable Cerebral Aneurysm
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Purpose: To evaluate the efficacy and stability of the wrap-clipping methods as a reconstructive strategy in the treatment of unclippable cerebral aneurysms. Materialsand Methods: Twenty four patients who had undergone wrap-clipping microsurgerywere 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. Results: 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 combinationof wrap-clip-wrap-holding clip revealed delayed branch occlusion and marked regrowing, respectively. Conclusion: Wrap-clipping strategy could be an easy and safe alternative for unclippable aneurysms. The wrapped aneurysm mostlydisappeared, 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.
Abstract
Purpose: To evaluate the efficacy and stability of the wrap-clipping methods as a reconstructive strategy in the treatment of unclippable cerebral aneurysms. Materialsand Methods: Twenty four patients who had undergone wrap-clipping microsurgerywere 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. Results: 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 combinationof wrap-clip-wrap-holding clip revealed delayed branch occlusion and marked regrowing, respectively. Conclusion: Wrap-clipping strategy could be an easy and safe alternative for unclippable aneurysms. The wrapped aneurysm mostlydisappeared, 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.
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