• Lukas Goertz, Boris Krischek, Michael Reiner, Roland Goldbrunner, and Gerrit Brinker.
• University of Cologne, Faculty of Medicine and University Hospital, Center for Neurosurgery, Department of General Neurosurgery, Cologne, Germany. Electronic address: lukas.goertz@uk-koeln.de.
• World Neurosurg. 2020 Jun 1; 138: 61-67.

BackgroundCerebral infarction because of parent artery stenosis represents a potential complication of microsurgical aneurysm clipping.Case DescriptionWe report a case of a 60-year-old woman that developed left-sided hemiparesis and aphasia 9 hours after clipping of an unruptured middle cerebral artery aneurysm with heavy calcification of the aneurysm neck. Angiographic workup revealed a marked parent artery stenosis, which occurred presumably because of thrombus generation at the reconstructed aneurysm neck. Revision surgery with relocation of the aneurysm clip was ultimately performed 19 hours after symptom onset. Although follow-up computed tomography scan showed a small cerebral infarction, the patient recovered fully from surgery.ConclusionsThis case shows that relocation of the aneurysm clip in case of vessel stenosis can lead to penumbral salvage, even when performed more than 6 hours after symptom onset.Copyright © 2020 Elsevier Inc. All rights reserved.

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