Self-closing Nitinol U-Clips for intracranial arterial microanastomosis: a preliminary experience on seven cases.
OBJECTIVE
To report experience on the use of self-closing nitinol U-Clips for different types of intracranial arterial microanastomosis.


METHODS
We treated 7 patients (3 females and 4 males, age ranging from 25 to 68 yo) admitted from November 2005 to January 2008 to the Neurological Institute C. Besta of Milan. One patient had cerebral hypoperfusion and the others a complex intracranial aneurysm. In each patient a bypass procedure was completed by using self-closing Nitinol U-Clips for intracranial arterial microanastomoses.


RESULTS
The total time of temporary occlusion was 15.71 +/- 4.386 min. Bypass patency was confirmed intraoperatively by near-infrared indocyanine green videoangiography and microdoppler in each patient. No spasm of the graft was encountered and immediate post-operative bypass patency was confirmed in 6/7 patients. The graft thrombosed in 1 patient with antiphospholipid syndrome. 1 patient died from a massive Subarachnoid Hemorrhage due to rupture of an aneurysm while waiting for an endovascular procedure. In the 5 patients at the last follow-up, long-term patency of the bypass was confirmed and no neurological deficits occurred related to the procedure.


CONCLUSIONS
This is the first report of the use of U-Clips for intracranial microanastomosis. Our data indicated that it is a safe technique, reduces the time taken to perform an anastomosis and the risk of an ischemic complication. Further studies of the longer-term patency of bypass as performed with U-Clips are required.
Ferroli
P
P
Department of Neurosurgery, Fondazione Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy. ferrolipaolo@hotmail.com
Acerbi
F
F
Tringali
G
G
Polvani
G
G
Parati
E
E
Broggi
G
G
D000328:Adult; D000368:Aged; D000792:Angiography; D002545:Brain Ischemia / Q000517:prevention & control; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control; D013525:Surgical Instruments / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D014741:Video Recording