Slow-Closing Clip for the Treatment of Nonsaccular Vertebrobasilar Aneurysms: A Retrospective Case Series

Authors

Behnam Rezai Jahromi, Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: behnam.rezai-jahromi@hus.fi.
Reza Dashti, Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA.
Oriela Rustemi, Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Neurosurgery, San Bortolo Hospital, Vicenza, Italy.
João M. Silva, Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Neurosurgery, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Riikka Tulamo, Department of Vascular Surgery and Neurosurgery Research Group, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Danil A. Kozyrev, Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Suvi Jauhiainen, Department of Immunology, Genetics, and Pathology Uppsala University, Uppsala, Sweden.
Peetra U. Magnusson, Department of Immunology, Genetics, and Pathology Uppsala University, Uppsala, Sweden.
Maximiliano Arce, Department of Immunology, Genetics, and Pathology Uppsala University, Uppsala, Sweden.
Hanna Kaukovalta, Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Christoph Schwartz, Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria.
Jussi Numminen, Department of Neuroradiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Stepan Sarpaneva, Sarpaneva Watches, Helsinki, Finland.
Valdemar Hirvelä, De Motu, Helsinki, Finland.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Rokuya Tanikawa, Sapporo Stroke Center Hiroyasu Kamiyama, Brain Disease Institute, Sapporo Teishinkai Hospital, Sapporo, Japan.
Mika Niemelä, Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Juha Hernesniemi, Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Juha Hernesniemi International Center for Neurosurgery, Henan Provincial Peoplés Hospital, Zhengzhou, China.

Document Type

Article

Abstract

OBJECTIVE: Vertebrobasilar artery nonsaccular aneurysms (VBANSAs) are associated with a 13% annual mortality. Revascularization and flow diversion are life-saving options in select cases; technical failures and rapid hemodynamic changes may contribute to unwanted outcomes. We describe a technique and report clinical outcomes of patients treated with an experimental slow-closing clip (SCC). METHODS: An experimental SCC was created to gradually close the parent artery of aneurysms. Clinical, radiographic, and outcome data from patients with VBANSAs who underwent experimental treatment with the SCC were retrospectively analyzed. RESULTS: Among 10 patients (7 men; mean age, 49.5 years; range, 18-73 years), 6 presented with mass effect symptoms, 1 with ischemic stroke, 2 with subarachnoid hemorrhage, and 1 with hydrocephalus. Five patients underwent revascularization plus SCC application, and 5 were treated with SCC alone. The mean follow-up was 6.7 years. The expected mortality among patients with unruptured VBANSAs with previous treatment options in this period was 52.7%, whereas the observed rate was 20%. Four patients died within 12 months after treatment. Causes of death were brainstem ischemic stroke, poor-grade subarachnoid hemorrhage, poor clinical presentation, and unknown. Six patients were alive at last follow-up, with unchanged or improved modified Rankin Scale scores. Mortality was associated with posterior-projecting aneurysms and late-stage treatment. CONCLUSIONS: In this small case series, use of SCC overcame the natural history of VBANSAs when treatment timing and aneurysm anatomy were suitable. The SCC potentially favors aneurysm thrombosis and collateral reactivation. More studies are necessary to better develop the SCC.

Medical Subject Headings

Male; Humans; Middle Aged; Intracranial Aneurysm (diagnostic imaging, surgery); Retrospective Studies; Subarachnoid Hemorrhage (diagnostic imaging, surgery); Treatment Outcome; Surgical Instruments; Brain Stem Infarctions; Ischemic Stroke

Publication Date

12-1-2022

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

168

First Page

e645

Last Page

e665

PubMed ID

36241141

Digital Object Identifier (DOI)

10.1016/j.wneu.2022.10.028

Recommended Citation

Rezai Jahromi, Behnam; Dashti, Reza; Rustemi, Oriela; Silva, João M.; Srinivasan, Visish M.; Tulamo, Riikka; Kozyrev, Danil A.; Jauhiainen, Suvi; Magnusson, Peetra U.; Arce, Maximiliano; Kaukovalta, Hanna; Schwartz, Christoph; Numminen, Jussi; Sarpaneva, Stepan; Hirvelä, Valdemar; Lawton, Michael T.; Tanikawa, Rokuya; Niemelä, Mika; and Hernesniemi, Juha, "Slow-Closing Clip for the Treatment of Nonsaccular Vertebrobasilar Aneurysms: A Retrospective Case Series" (2022). Neurosurgery. 1836.
https://scholar.barrowneuro.org/neurosurgery/1836