title: Long-term clinical and angiographic outcomes of wrap-clipping strategies for unclippable cerebral aneurysms.
abstract: OBJECTIVE
  To evaluate the efficacy and stability of the wrap-clipping methods as a reconstructive strategy in the treatment of unclippable cerebral aneurysms.
  
  
  METHODS
  Twenty four patients who had undergone wrap-clipping microsurgery were retrospectively reviewed. Type and morphology of the treated aneurysm, utilized technique for wrap-clip procedure, and clinical outcome with angiographic results at their last follow-up were evaluated.
  
  
  RESULTS
  Of 24 patients, eleven patients had internal carotid artery (ICA) blister-like aneurysms, three had dissecting type aneurysms, and ten had fusiform aneurysms. The follow-up period for the late clinical and angiographic results ranged from 10 to 75 months (mean 35 months). Wrap-clipping was performed in eleven, wrap-holding clipping was in ten, and combination of wrap-clip and wrap-holding clip was in three cases. At the last angiographic follow-up study, twelve aneurysms (50%) were found to have completely healed, and nine aneurysms (38%) were at least stable. However, wrap-holding clip for the elongated blister type of ICA aneurysm was found failed, leading to fatal rebleeding in one case, and two cases of combination of wrap-clip-wrap-holding clip revealed delayed branch occlusion and marked regrowing, respectively.
  
  
  CONCLUSIONS
  Wrap-clipping strategy could be an easy and safe alternative for unclippable aneurysms. The wrapped aneurysm mostly disappeared, or at least remained stationary, after a long-term period. However, surgeons should be aware of that the wrapped aneurysm might become worse. Therefore, follow-up surveillance for an extended period should be mandatory.
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. sk522@yuhs.ac.
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Hong
authors.forename: Joonho
authors.initials: J
authors.lastname: Chung
authors.forename: Jin Yang
authors.initials: JY
authors.lastname: Joo
authors.forename: Seung-Kon
authors.initials: SK
authors.lastname: Huh
mesh_terms: D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cerebral aneurysms; follow-up; unclippable; wrap-clipping