Maintenance of cerebral blood flow during microsuture repair of the superior wall of the intracranial internal carotid artery.

OBJECTIVE

Certain clinical situations, such as a surgical embolectomy for an acute embolic occlusion of the internal carotid artery (ICA) or the surgical repair of a blood blister-like aneurysm (BBA), can require the superior wall of the ICA to be repaired using a microsuture technique. This can be complicated and challenging, as it not only involves delicate work in a deep surgical field but is also a time-limited procedure performed during temporary occlusion of the ICA. Thus, to facilitate a less complicated repair of the ICA and maintenance of the cerebral blood flow during the procedure, a microsuture technique using compartmentalizing clips is proposed.

METHODS

A single aneurysm clip with C-shaped blades or two aneurysm clips with J-shaped blades facing each other are placed to compartmentalize the arteriotomy or arterial defect of the superior wall of the supraclinoid ICA. The lesion can then be sutured without temporary occlusion of the parent artery.

RESULTS

Two such cases are reported: a 78-year-old woman who presented with an acute ischemic stroke and experienced unintentional detachment of a retrieval intracranial stent in the ICA, and a 58-year-old woman who presented with a BBA. In each case, the proposed microsuture technique was successfully used with a supraorbital keyhole approach and a pterional approach, respectively.

CONCLUSIONS

The proposed microsuture technique using compartmentalizing clips facilitates the repair of the ICA in cases of a surgical embolectomy or BBA without temporary occlusion of the ICA.