Retrograde Suction Decompression for Clip Occlusion of Internal Carotid Artery Communicating Segment Aneurysms

Retrograde suction decompression (RSD) can achieve proximal parent vessel control, improve aneurysm neck visualization, and allow parent vessel reconstruction for direct clipping of internal carotid artery (ICA) aneurysms. The aim of the present study was to describe the technique and surgical results of RSD for direct clipping of ICA communicating segment (C1) aneurysms.

The clinical data and treatment summaries of 20 patients who underwent RSD-assisted clipping of ICA C1 aneurysms were retrospectively reviewed. Pre- and postoperative three- or four-dimensional computed tomography angiograms, postoperative magnetic resonance images, surgical notes, operative complications, and outcomes were assessed.

All patients except one harbored unruptured C1 aneurysms. Extracranial-intracranial graft bypass using the radial artery was performed in five patients. Fifteen patients required temporary clipping of the posterior communicating artery for further reduction of blood back-flow into the aneurysm. All aneurysms were successfully clipped and postoperative three- or four-dimensional computed tomography angiography revealed no major branch occlusion or residual aneurysm. At the 6-month follow-up examination, 19 patients had a good outcome and 1 patient had poor outcome associated with anterior choroidal artery ischemia. No death had occurred at 6-month follow-up examination.

The RSD technique is a useful procedure to achieve proximal vascular control, to soften and shrinkage the aneurysm sac, and to provide a wide and clean operative field allowing safe clip placement. The RSD technique requires special attention to the relationship between the perforators and the aneurysm, and close cooperation between the surgeon and the assistant.