• P Ferroli, F Acerbi, G Tringali, G Polvani, E Parati, and G Broggi.
• Department of Neurosurgery, Fondazione Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy. ferrolipaolo@hotmail.com
• Acta Neurochir (Wien). 2009 Aug 1; 151 (8): 969-76; discussion 976.

PurposeTo report experience on the use of self-closing nitinol U-Clips for different types of intracranial arterial microanastomosis.MethodsWe treated 7 patients (3 females and 4 males, age ranging from 25 to 68 yo) admitted from November 2005 to January 2008 to the Neurological Institute C. Besta of Milan. One patient had cerebral hypoperfusion and the others a complex intracranial aneurysm. In each patient a bypass procedure was completed by using self-closing Nitinol U-Clips for intracranial arterial microanastomoses.ResultsThe total time of temporary occlusion was 15.71 +/- 4.386 min. Bypass patency was confirmed intraoperatively by near-infrared indocyanine green videoangiography and microdoppler in each patient. No spasm of the graft was encountered and immediate post-operative bypass patency was confirmed in 6/7 patients. The graft thrombosed in 1 patient with antiphospholipid syndrome. 1 patient died from a massive Subarachnoid Hemorrhage due to rupture of an aneurysm while waiting for an endovascular procedure. In the 5 patients at the last follow-up, long-term patency of the bypass was confirmed and no neurological deficits occurred related to the procedure.ConclusionThis is the first report of the use of U-Clips for intracranial microanastomosis. Our data indicated that it is a safe technique, reduces the time taken to perform an anastomosis and the risk of an ischemic complication. Further studies of the longer-term patency of bypass as performed with U-Clips are required.

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