Self-closing Nitinol U-Clips for intracranial arterial microanastomosis: a preliminary experience on seven cases

Acta Neurochir (Wien). 2009 Aug;151(8):969-76; discussion 976. doi: 10.1007/s00701-009-0365-7. Epub 2009 May 15.


Purpose: To report experience on the use of self-closing nitinol U-Clips for different types of intracranial arterial microanastomosis.

Methods: We 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.

Results: The 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.

Conclusion: This 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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Angiography
  • Brain Ischemia / prevention & control
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / pathology
  • Cerebral Arteries / surgery*
  • Female
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Monitoring, Intraoperative
  • Neurosurgical Procedures / instrumentation*
  • Neurosurgical Procedures / methods
  • Outcome Assessment, Health Care
  • Postoperative Complications / prevention & control
  • Surgical Instruments / standards
  • Surgical Instruments / statistics & numerical data*
  • Surgical Instruments / trends
  • Treatment Outcome
  • Vascular Surgical Procedures / instrumentation*
  • Vascular Surgical Procedures / methods
  • Video Recording