title: Balloon-assisted clipping of a large paraclinoidal aneurysm: a salvage procedure.
abstract: OBJECTIVE
  Surgical clipping and parent vessel reconstruction of wide-neck paraclinoid aneurysms can be very challenging. We report a case of a ruptured paraclinoid aneurysm which failed standard clipping techniques. We were able to reconstruct this aneurysm while providing proximal and distal control using an adjuvant endovascular balloon.
  
  
  METHODS
  We report the case of a 45-year-old woman presenting with a ruptured large paraclinoidal aneurysm, which involved a significant portion of the internal carotid artery wall.
  
  
  METHODS
  Repeated attempts at fenestrated clip placement resulted in slipping of the clip and occlusion of the parent artery. Ultimately, the aneurysm ruptured at the neck, and, despite trapping and direct aneurysmal suction decompression, significant bleeding was encountered. The bleeding point was packed, and, subsequently, endovascular access was obtained. A balloon was navigated and then inflated across the neck of the aneurysm using C-arm fluoroscopic guidance. The aneurysm was successfully clipped, and intraoperative angiography demonstrated no parent vessel stenosis.
  
  
  CONCLUSIONS
  This case demonstrates a salvage procedure in the event of intraoperative rupture and inadequate interruption of local blood flow. Balloon inflation resulted in adequate hemostasis and provided intraluminal support for optimal clip placement while preserving the parent artery.
authors.affiliation: Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA
authors.forename: Mohamed Samy
authors.initials: MS
authors.lastname: Elhammady
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.forename: Hamad
authors.initials: H
authors.lastname: Farhat
authors.forename: Jacques J
authors.initials: JJ
authors.lastname: Morcos
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
mesh_terms: D000785:Aneurysm, Infected / Q000150:complications / Q000601:surgery*; D000800:Angioplasty, Balloon / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010229:Paracoccidioidomycosis / Q000150:complications / Q000601:surgery*; D013525:Surgical Instruments; D014656:Vascular Surgical Procedures / Q000379:methods*