An attempt was made to clip the neck of a large paraclinoid aneurysm with the support of a balloon catheter, using a trapping-evacuation technique. The clip applied to the neck slipped off because of blood pressure through the posterior communicating artery which arose from the dome of the aneurysm.
Therefore, using portable digital subtraction angiography (DSA) equipment, we placed interlocking detachable coils (IDCs) in the aneurysm for the purpose of reducing the intraaneurysmal pressure.
Although the aneurysm was eventually trapped with two clips, this case indicates the supportive role of intravascular intervention in aneurysmal surgery when clipping an aneurysm or immediately after clip failure.
BatjerHHKopilnikTA: Surgery for paraclinoidal artery aneurysms. J Neurosurg80: 650–658, 1994.
2.
TamakiNKimS: Giant carotid-ophthalmic artery aneurysms: Direct clipping utilizing the “trapping-evacuation” technique. J Neurosurg74: 567–572, 1991.
3.
AlbertFKForstingM: Clipping of proximal paraclinoid aneurysms with support of the balloon-catheter “trapping-evacuation” technique. Technical Note. Acta Neurochir (Wien)125: 138–141, 1993.
4.
FahlbuschRNimskyC: Open surgery of giant paraclinoid aneurysms improved by intraoperative angiography and endovascular retrograde suction decompression. Acta Neurochir (Wien)139: 1026–1032, 1997.
5.
LarsonJJTewJM: Treatment of aneurysms of the internal carotid artery by intravascular balloon occlusion: Long-term follow-up of 58 patients. Neurosurgery36: 23–30, 1995.
6.
RoyDRaymondJ: Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils. Am J Neuroradiol18: 1207–1215, 1997.
7.
RaymondJRoyD: Safely and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery41: 1235–1246, 1997.
8.
DerdeynCPMoranCJ: Intracranial aneurysm: Anatomic factors that predict the usefulness of intraoperative angiography. Radiology205: 335–339, 1997.
