Titanium aneurysm clips: Part I--Mechanical, radiological, and biocompatibility testing

Most aneurysm clips are made of cobalt-based alloys. Although these clips are nonferromagnetic, they still produce artifact that degrades the quality of magnetic resonance (MR) images. A new aneurysm clip of pure titanium was developed to minimize artifact on postoperative MR images. We evaluated these clips in a series of mechanical tests in vitro, biocompatibility tests in rabbits, and radiological tests in greyhound dogs. The clip sizes and shapes matched those of conventional aneurysm clips. The average closing forces ranged between 151.6 and 181.8 g and were not diminished by repeated sterilization or stress. After > 20 million cycles of high-pressure and high-frequency pulsations, the clips did not open and the closing forces were not reduced. Titanium aneurysm clips implanted in the subarachnoid space of 12 rabbits for 1 or 6 months produced mild gliosis identical to that produced by implantation of cobalt alloy clips in 12 control rabbits. Based on pre- and postoperative weights and electron microscopic scans, the titanium implants did not corrode. The artifact on computed tomographic and MR imaging produced by a titanium clip placed on the internal carotid artery of a greyhound was less than that produced by an identical cobalt-chrome alloy clip by a factor of two to three. This study demonstrated that titanium aneurysm clips are mechanically equivalent to conventional clips, biocompatible, and corrosion resistant. Furthermore, titanium clips have superior imaging characteristics, creating less computed tomographic and MR imaging artifact and permitting better resolution of anatomic structures than cobalt alloy clips.