2020 年 48 巻 1 号 p. 18-24
Clipping of internal carotid artery (ICA)-anterior choroidal artery (AchA) aneurysms (IC-AchA An) is associated with a high rate of ischemic complications, particularly in cases of AchA arising from the dome. Therefore, although angioplastic dome clipping is required, very few reports have described the clipping methods. We therefore focused on these and discuss them together with the outcomes of such aneurysms. Specifically, 35 consecutive surgical patients (36 cases of IC-Ach An), treated between September 2006 and May 2018, were retrospectively investigated. Of these, 6 cases with the AchA arising from the dome were selected for the present study. In all cases, the AchA branching sites were on the dorsal side of the dome. Anatomically, the AchA arises from the posterolateral wall of the ICA and extends supero-postero-laterally, whereas the IC-AchA An projects laterally. Therefore, clipping is considered possible on the ventral side of the dome. While clipping of three aneurysms with diameters of 4 mm (or lower) could be performed using a single clip, angioplastic clipping of three aneurysms with a diameter greater than 4 mm required two clips. In addition, two curved clips were used for aneurysms on the right side, whereas two straight clips were used for those on the left side to obliterate the fundus and the ventral side of the aneurysm. None of the patients presented either ischemic findings or aneurysm regrowth at the follow-up.