Wrap-clipping with polytetrafluoroethylene for ruptured blisterlike aneurysms of the internal carotid artery

Technical note

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✓ A technique combining wrapping and clip occlusion of aneurysms by using polytetrafluoroethylene (PTFE) for treatment of ruptured blisterlike aneurysms of the supraclinoid internal carotid artery (ICA) is described. The diameter of the abnormal arterial lesion along the long axis of the ICA and the distance between the origin of the ophthalmic artery and the origin of the posterior communicating artery (PCoA), or the origin of the PCoA and the origin of the anterior choroidal artery are measured intraoperatively; a strip of PTFE membrane is then trimmed with scissors to match this diameter and distance. After temporarily occluding the cervical ICA, the intracranial ICA that includes the lesion is wrapped with the strip of PTFE, and one or more aneurysm clips are applied parallel to the ICA. This procedure was successfully accomplished in six patients, all of whom had an uneventful postoperative course with no recurrent subarachnoid hemorrhage during the follow-up period. “Wrap-clipping” using PTFE is a useful procedure for management of ruptured blisterlike aneurysms of the ICA.

Abbreviations used in this paper:AChA = anterior choroidal artery; ICA = internal carotid artery; PCoA = posterior communicating artery; PTFE = polytetrafluoroethylene.
Article Information

Contributor Notes

Address reprint requests to: Yoshitaka Kubo, M.D., Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan. email: yokubo@iwate-med.ac.jp.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Abe MTabuchi KYokoyama HUchino A: Blood blister-like aneurysms of the internal carotid artery. J Neurosurg 89:4194241998

  • 2

    AbuRahma AFHannay RSKhan JHRobinson PAHudson JKDavis EA: Prospective randomized study of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated Dacron (Hemashield) patching: perioperative (30-day) results. J Vasc Surg 35:1251302002

    • Search Google Scholar
    • Export Citation
  • 3

    AbuRahma AFHopkins ESRobinson PADeel JTAgarwal S: Prospective randomized trial of carotid endarterectomy with poly-tetrafluoroethylene versus collagen-impregnated dacron (Hema-shield) patching: late follow-up. Ann Surg 237:8858932003

    • Search Google Scholar
    • Export Citation
  • 4

    Aliredjo RPde Vries JMenovsky TGrotenhuis JAMerx J: The use of Gore-Tex membrane for adhesion prevention in tethered spinal cord surgery: technical case reports. Neurosurgery 44:6746781999

    • Search Google Scholar
    • Export Citation
  • 5

    Elliott MPJuler GL: Comparison of Marlex mesh and micro-porous teflon sheets when used for hernia repair in the experimental animal. Am J Surg 137:3423441979

    • Search Google Scholar
    • Export Citation
  • 6

    Fujitsu KIshiwata YGondo GFujii SFeng DD: Wrap-clipping with a Dacron mesh Silastic sheet. Technical note. J Neurosurg 80:3363371994

    • Search Google Scholar
    • Export Citation
  • 7

    Gibo HLenkey CRhoton AL Jr: Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55:5605741981

    • Search Google Scholar
    • Export Citation
  • 8

    Hunt WEKosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79891974

  • 9

    Karasawa HMatsumoto HNaito HSugiyama KUeno JKin H: [Superior wall aneurysms of the internal carotid artery: Intraoperative findings and operative technique.]. Jpn J Neurosurg 5:2732801996. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 10

    Nakagawa FKobayashi STakemae TSugita K: Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 65:3033081986

    • Search Google Scholar
    • Export Citation
  • 11

    Nakagawa SHayashi TAnegawa SNakashima SShimokawa SFurukawa Y: Postoperative infection after duraplasty with expanded polytetrafluoroethylene sheet. Neurol Med Chir (Tokyo) 43:1201242003

    • Search Google Scholar
    • Export Citation
  • 12

    Nakano SIseda TYoneyama TIkeda TGoya TWakisaka S: A combination of wrapping and clipping using a collagen-impregnated dacron fabric (Hemashield). Surg Neurol 53:3303332000

    • Search Google Scholar
    • Export Citation
  • 13

    Ogawa ASuzuki MOgasawara K: Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery 47:5785862000

    • Search Google Scholar
    • Export Citation
  • 14

    Rankin J: Cerebral vascular accidents in patients over the age of 60. II Prognosis. Scott Med J 2:2002151957

  • 15

    Shigeta HKyoshima KNakagawa FKobayashi S: Dorsal internal carotid artery aneurysms with special reference to angiographic presentation and surgical management. Acta Neurochir (Wien) 119:42481992

    • Search Google Scholar
    • Export Citation
  • 16

    Yamagata SGoto KOda YKikuchi H: Clinical experience with expanded polytetrafluoroethylene sheet used as an artificial dura mater. Neurol Med Chir (Tokyo) 33:5825851993

    • Search Google Scholar
    • Export Citation
  • 17

    Yanagisawa TMizoi KSugawara TSuzuki AOhta THigashiyama N: Direct repair of a blisterlike aneurysm on the internal carotid artery with vascular closure staple clips. Technical note. J Neurosurg 100:1461492004

    • Search Google Scholar
    • Export Citation
  • 18

    Yanaka KMeguro KNose T: Repair of a tear at the base of a blister-like aneurysm with suturing and an encircling clip: technical note. Neurosurgery 50:2182212002

    • Search Google Scholar
    • Export Citation
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