Surgery of a large paraclinoid aneurysm with the support of coil embolization

An attempt was made to clip the neck of a large paraclinoid aneurysm with the support of a balloon catheter, using a trapping-evacuation technique. The clip applied to the neck slipped off because of blood pressure through the posterior communicating artery which arose from the dome of the aneurysm. Therefore, using portable digital subtraction angiography (DSA) equipment, we placed interlocking detachable coils (IDCs) in the aneurysm for the purpose of reducing the intraaneurysmal pressure. Although the aneurysm was eventually trapped with two clips, this case indicates the supportive role of intravascular intervention in aneurysmal surgery when clipping an aneurysm or immediately after clip failure.