Complete neck clipping of internal carotid-posterior communicating artery aneurysms using bayonet-shaped aneurysm...

Neck clipping for internal carotid-posterior communicating artery (IC-PC) aneurysms using standard straight, angled, or curved clip may result in remnant aneurysm neck. We describe complete neck clipping of IC-PC aneurysms using a bayonet-shaped clip. The bayonet-shaped clip is applied perpendicular to the long axis of the internal carotid artery (ICA), and the blades of the clip are inserted between the aneurysm neck and the ICA. Using the clip applicator, the clip is gradually rotated counterclockwise or clockwise for left or right ICA aneurysm, respectively, so that the distal and shank portions of the clip blade are located at the aneurysm neck in the posterior communicating artery (Pcom) and ICA, respectively. As a result, the distal flexure of the clip blade fits the junction of the ICA and Pcom. This technique was used in four patients with ruptured ICA aneurysms and five patients with unruptured ICA aneurysms. Postoperative cerebral angiography demonstrated no residual aneurysm neck and preservation of the Pcom in all patients. This technique is useful for cases of IC-PC aneurysm involving the origin of the Pcom.