Clip-Grafts for Aneurysm and Small Vessel Surgery

Part 3: Clinical Experience in Intracranial Internal Carotid Artery Aneurysms

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Figures

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    Application of a 3.5 × 5 mm clip-graft to an aneurysm projecting laterally under the edge of the tentorium. The clip-graft is demonstrated being applied at an angle to the aneurysm of approximately 120°, with the miniaturized clip holder. Carotid aneurysms in this location with this projection have been the most common in this series.

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    Typical pre- and postoperative arteriograms of a carotid artery aneurysm projecting laterally under the edge of the tentorium. Note the contrast medium can be visualized through the lumen of the clip-graft in the postoperative film.

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    Application of a 3.5 × 5 mm clip-graft to an aneurysm projecting laterally above the edge of the tentorium. The clip-graft is illustrated being applied with an angled clip holder to allow the angle of application to the aneurysm to be as great as possible.

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    Typical pre- and postoperative arteriograms of aneurysm projecting laterally above the tentorium. The Mayfield clip was applied in this case to the posterior communicating artery to control a minimal amount of back-bleeding from this vessel. This is seldom necessary.

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    Application of a 3.5 × 5 mm clip-graft to an aneurysm projecting medially from the carotid artery under the optic nerve. These aneurysms are easily treated with the clip-graft.

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    Typical pre- and postoperative arteriograms of an aneurysm projecting medially from the carotid artery under the optic nerve. Note the contrast medium is visualized through the clip on the postoperative study.

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    Application of a 4.0 × 5 mm clip-graft to an aneurysm projecting superiorly from the carotid artery. This aneurysm was far enough distal on the carotid artery so that it could be treated with the clip-graft, but many aneurysms in this location are too far proximal on the carotid artery to be successfully treated with this type of clip.

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    Typical pre- and postoperative arteriograms of an aneurysm projecting superiorly from the carotid artery. This is an arteriogram of a so-called “blister” which arose from the dorsal aspect of a fusiform dilatation of the carotid artery. At surgery there was fresh clot around the vessel and fibrinous material over the dome of the blister so that there was no question that this was the aneurysm which had bled. The patient made an excellent recovery. The clip-graft is somewhat hidden from view behind the sphenoid wing on the postoperative study.

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    Application of a beveled clip-graft to an aneurysm at the bifurcation of the carotid artery. The beveled clip-graft is used to avoid encroachment on the carotid artery as the clip-graft is placed to reinforce the bifurcation site.

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    Typical pre- and postoperative arteriograms of an aneurysm located at the bifurcation of the internal carotid artery. This grade IV patient made an excellent recovery.

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    Typical pre- and postoperative arteriograms of an aneurysm which ruptured prior to its identification. A. 3.0 × 7 mm clip-graft was placed circumferentially around the carotid artery sealing the defect in the vessel wall which gave rise to the aneurysm. This patient, a grade I candidate, made an excellent recovery. Note the contrast medium through the clip on the postoperative film.

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