• Rezai JahromiBehnamBDepartment of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: behnam.rezai-jahromi@hus.fi., Reza Dashti, Oriela Rustemi, João M Silva, Visish M Srinivasan, Riikka Tulamo, Danil A Kozyrev, Suvi Jauhiainen, Peetra U Magnusson, Maximiliano Arce, Hanna Kaukovalta, Christoph Schwartz, Jussi Numminen, Stepan Sarpaneva, Valdemar Hirvelä, Michael T Lawton, Rokuya Tanikawa, Mika Niemelä, and Juha Hernesniemi.
• Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: behnam.rezai-jahromi@hus.fi.
• World Neurosurg. 2022 Dec 1; 168: e645e665e645-e665.

ObjectiveVertebrobasilar artery nonsaccular aneurysms (VBANSAs) are associated with a 13% annual mortality. Revascularization and flow diversion are life-saving options in select cases; technical failures and rapid hemodynamic changes may contribute to unwanted outcomes. We describe a technique and report clinical outcomes of patients treated with an experimental slow-closing clip (SCC).MethodsAn experimental SCC was created to gradually close the parent artery of aneurysms. Clinical, radiographic, and outcome data from patients with VBANSAs who underwent experimental treatment with the SCC were retrospectively analyzed.ResultsAmong 10 patients (7 men; mean age, 49.5 years; range, 18-73 years), 6 presented with mass effect symptoms, 1 with ischemic stroke, 2 with subarachnoid hemorrhage, and 1 with hydrocephalus. Five patients underwent revascularization plus SCC application, and 5 were treated with SCC alone. The mean follow-up was 6.7 years. The expected mortality among patients with unruptured VBANSAs with previous treatment options in this period was 52.7%, whereas the observed rate was 20%. Four patients died within 12 months after treatment. Causes of death were brainstem ischemic stroke, poor-grade subarachnoid hemorrhage, poor clinical presentation, and unknown. Six patients were alive at last follow-up, with unchanged or improved modified Rankin Scale scores. Mortality was associated with posterior-projecting aneurysms and late-stage treatment.ConclusionsIn this small case series, use of SCC overcame the natural history of VBANSAs when treatment timing and aneurysm anatomy were suitable. The SCC potentially favors aneurysm thrombosis and collateral reactivation. More studies are necessary to better develop the SCC.Copyright © 2022 Elsevier Inc. All rights reserved.

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