title: Arterial suturing followed by clip reinforcement with circumferential wrapping for blister-like aneurysms of the internal carotid artery.
abstract: OBJECTIVE
  Blister-like aneurysms of the internal carotid artery (ICA) are very fragile, thin-walled aneurysms. These lesions are susceptible to premature rupture intraoperatively. We describe two cases of successful arterial suturing of these blister-like aneurysms of the ICA, followed by a clip reinforcement technique and circumferential wrapping with a silastic sheet.
  
  
  METHODS
  Two young men presented with a diffuse and dense subarachnoid hemorrhage (SAH) in the basal cistern. The initial angiogram obtained soon after the SAH showed a broad-based, small bulging appearance of the dorsal wall of the ICA. Intraoperatively, a very thin-walled aneurysm was identified on the C2 and C1 segment of the ICA. The aneurysms ruptured abruptly during surgical manipulation. After application of temporary clips, an aneurysmal tear of the ICA was repaired with 8-0 nylon. To prevent the regrowth of the aneurysm, clip reinforcement, by circumferential wrapping with a transparent silicone sheet, was added.
  
  
  RESULTS
  The postoperative clinical course was uneventful, although one patient showed transient right hemiparesis due to cerebral vasospasm. Angiographic studies performed postoperatively showed complete obliteration of the aneurysm as well as a patent ICA lumen in one case and total occlusion of the ICA in the other case. Both patients were discharged with no neurological deficits.
  
  
  CONCLUSIONS
  This technique can be a useful treatment option for these fragile aneurysms in cases where other options, such as direct clips or encircling clips, may be impossible.
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
authors.forename: Sung-Pil
authors.initials: SP
authors.lastname: Joo
authors.forename: Tae-Sun
authors.initials: TS
authors.lastname: Kim
authors.forename: Kyung-Sub
authors.initials: KS
authors.lastname: Moon
authors.forename: Hyoung-Jun
authors.initials: HJ
authors.lastname: Kwak
authors.forename: Jung-Kil
authors.initials: JK
authors.lastname: Lee
authors.forename: Jae-Hyoo
authors.initials: JH
authors.lastname: Kim
authors.forename: Soo-Han
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D006261:Headache / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D019736:Prostheses and Implants / Q000592:standards / Q000639:trends*; D012828:Silicones / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013525:Surgical Instruments / Q000592:standards; D013536:Suture Techniques / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D014839:Vomiting / Q000209:etiology
chemical_list: D012828:Silicones