Stent-Assisted Clip Placement for Complex Internal Carotid Artery Intracranial Aneurysms

We report two procedures using a stent-assisted microsurgical clip placement to treat complex intracranial aneurysms originating from supraclinoid segment of the internal carotid artery. In both procedures, primary clip placement was considered technically difficult due to either complex morphology or inferior protrusion of aneurysm fundus within the interclinoid space. A nitinol self-expanding stent was placed across the neck of the aneurysm either preoperatively or intraoperatively. Obliteration of aneurysm and patency of the artery was confirmed by angiography after clip placement. Description of an integrated open microsurgical and endovascular approach and review of literature pertaining to considerations for treatment approach are discussed.