We describe a technique of clipping on wrapping method using Bemsheet to treat short aneurysms such as broad-based aneurysms, so-called blister aneurysms and dissecting aneurysms. After the aneurysm and its parent artery have been circumferentially wrapped with a strip of Bemsheet, an aneurysm clip is applied on the sheet to clip the aneurysm between the 2 leaves of the sheet utilizing the counter-pressure effect between the clip and the sheet pulled by forceps. This technique avoids several risks, including slipping out of the clip or neck avulsion during clip application to blister aneurysms because the sheet cushions the hard blade of the clip. Furthermore, recurrence of aneurysm following incomplete neck obliteration is also avoided due to tethering effect of the sheet to the clip.
Twenty-three of 25 patients for whom this method was employed were successfully treated by complete occlusion of aneurysm. One patient with a blister aneurysm originating from the anterior wall of the internal carotid artery died of rerupture of aneurysm due to possible incomplete neck obliteration. One patient developed postoperative narrowing of the parent artery.
The most important key point of this technique for blister aneurysm arising from internal carotid artery is to tighten the sling of 2 strips of the sheet which were placed proximally and distally to posterior communicating. And those strips were pulled strongly by forceps perpendicularly to the internal carotid artery in order to obtain the most effective counter-pressure. To avoid the possibility of postoperative narrowing of parent artery due to granuloma formation, plastic adhesive should not be used.