Microsurgical clipping of ruptured anterior choroidal artery aneurysms: Incidence of and risk factors for ischemic complications

Objective: Temporary clipping of the internal carotid artery can be required during microsurgery of a ruptured anterior choroidal artery (AchoA) aneurysm. Although it is suspected that such temporary clipping might be related to ischemic complications following surgery, no detailed analysis has been reported yet. Patients and methods: Eighty-nine patients with ruptured AchoA aneurysms treated by microsurgical clipping were recruited between January 1996 and December 2017. Patient medical records, radiographic data, and intraoperative video findings were retrospectively reviewed. Multivariate logistic regression analysis was conducted to investigate the risk factors for treatment-related ischemic complications. Results: Treatment-related ischemic complications occurred in eight (9.0 %) patients, all of whom underwent temporary clipping during microsurgery. Patients who did not undergo temporary clipping (n = 20) did not experience treatment-related ischemic complications. Among patients who underwent temporary clipping (n = 69), multivariate logistic regression analyses indicated that the total duration, number of attempts, and longest time per attempt were not risk factors for poor clinical outcome at discharge. However, the longest time per attempt was identified as the only independent risk factor for treatment-related ischemic complications (odds ratio, 2.883; 95 % confidence interval, 1.725-6.525; P = 0.042). Conclusion: The longest time per attempt might be associated with a higher risk of treatment-related ischemic complications during microsurgery for ruptured AchoA aneurysms. Treatment-related ischemic complications may be minimized by intermittent application of temporary clipping during surgery.restrictio