title: A novel aneurysm clip design for atheromatous, thrombotic, or previously coiled lesions: preliminary experience with the "compression clip" in 6 cases.
abstract: BACKGROUND
  Large and giant lesions often have thicker, atheromatous walls as well as intra-aneurysmal thrombus that combine to prevent traditional clips from closing properly in some cases.
  
  
  OBJECTIVE
  To report the development and use of a novel clip design specifically tailored to treat atheromatous, thrombotic, or previously coiled aneurysms.
  
  
  METHODS
  We retrospectively reviewed the records of 6 patients with complex aneurysms not amenable to simple neck clipping and not considered appropriate for endovascular therapy who were treated using a novel "compression" clip design. We describe the development and use of a novel aneurysm clip design with blades that are not opposed at rest to allow direct clipping of atheromatous, thrombotic, and previously coiled aneurysms.
  
  
  RESULTS
  Four patients had recurrent, previously coiled aneurysms; one of these also had a large thrombotic component. Two patients had complex lesions with heavy atheroma involving a portion of their aneurysms. There were no complications related to the use of the clip, and all patients did well without neurological complications. In every case, the clip allowed straightforward obliteration of the aneurysm without the need for temporary vascular occlusion, aneurysmorrhaphy, or removal of an intra-aneurysmal coil mass. All patients underwent intraoperative angiography to confirm obliteration of the aneurysm with preservation of the normal vasculature.
  
  
  CONCLUSIONS
  Atheromatous, thrombotic, and previously coiled aneurysms may not be treatable with simple neck clipping and may not be curable with endovascular therapy. For such cases, we designed a novel "compression" clip that has been used safely and successfully in our experience with good short-term follow-up.
authors.affiliation: National Brain Aneurysm Center, St. Joseph's Hospital, St. Paul, Minnesota, USA. lnussbaum@comcast.net
authors.forename: Eric S
authors.initials: ES
authors.lastname: Nussbaum
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Nussbaum
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000592:standards / Q000639:trends*; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods