Fenestrated T-bar Clips in Surgical Management of Internal Carotid Artery Aneurysms: Technical Note.

Abstract

Using a conventional right-angled fenestrated clip for an internal carotid artery (ICA) aneurysm is potentially disadvantageous because of the worse surgical visibility during and after clip application, especially in tight surgical fields. We report a case of ruptured posteromedially projecting ICA aneurysm treated using a right-angled fenestrated T-bar clip (Yasargil titanium clip, Aesculap AG & Co, Tuttlingen, Germany). A 52-year-old woman was admitted to our hospital with severe headache. Three-dimensional computed tomography angiography showed a saccular aneurysm arising from the left, unusually short ICA, located proximal to the anterior choroidal artery. The right-angled fenestrated T-bar clip (blade length, 5 mm) was applied across the ICA, followed by reconstruction of the ICA wall with preservation of the anterior choroidal artery and simultaneous obliteration of the aneurysm. The key characteristic of the fenestrated T-bar clip is that the fenestrated portion of the clip is connected to the center of the blades. The tips of the blades on both sides are thus clearly visible during clip application. Application of the T-bar clip allows the surgeon to perform clip ligation of a posteromedially projecting ICA aneurysm while preserving the adjacent perforating artery.