MULTIPLE CLIPPING TECHNIQUE FOR LARGE AND GIANT INTERNAL CAROTID-ARTERY ANEURYSMS AND COMPLICATIONS - ANGIOGRAPHIC ANALYSIS

Experience with surgical clipping of 16 large and nine giant aneurysms of the intradural internal carotid artery (ICA) is described. Reconst ruction of the parent artery with part of the aneurysmal wall was nece ssary in the majority of cases. Multiple clips were required for satis factory clipping in 20 cases. Complications related to the clipping pr ocedure comprised occlusion and stenosis of the parent carotid artery in isolated cases. Straightening of the parent carotid artery with con sequent kinking of the middle cerebral artery was seen in three cases of an aneurysm with a dome directed ventrally in the proximal segment of the ICA. The factors that caused straightening of the ICA are analy zed. It was observed that an excessive change in the direction of the ICA can cause cerebral infarction.