PMC4538576_01
Case 1. (a) Head computed tomography scan. (b) Three-dimensional computed tomography angiography showing a gourd-shaped regrown aneurysm under the clip (implanted for 35 years) at left middle cerebral artery bifurcation. (c) Schematic image of the regrown aneurysm. (d) Intraoperative photograph showing the old clip with cotton clothes on the regrown aneurysm. (e) A crank-shaped clip was applied along the closure line
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F1
It was determined that he had suffered a second SAH due to a rupture of the original aneurysm [Figure 1a]. At the hospital, he underwent three-dimensional computed tomography (CT) angiography (CTA) for the SAH, revealing a gourd-shaped aneurysm with the old clip attached at its dome [Figure 1b and c]. After careful removal of sylvian fissure hematoma, the old clip was identified [Figure 1d]. The large dome was then cut out, and a crank-shaped clip was applied to make a closure line [Figure 1e].
(a) Photographs depicting the retrieved Yasargil clips (FD742). (b) Graphs revealing the profile of the retrieved clip analyzed using X-ray photoelectron spectroscopy. (c and d) Scanning electron micrographs of the retrieved clip
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F2
It was a second-generation product (code number, FD742), and there was no severe damage or any corrosion [Figure 2a]. X-ray photoelectron spectroscopy (XRP) revealed that it was made of stainless steel, and the constituent of the metal was not changed after extremely long-term implantation [Figure 2b]. Black spots on its surface were speculated to be a residue of organic products [Figure 2c and d].
PMC4538576_02
Case 2. (a) Head computed tomography scan. (b) Three-dimensional angiography showing a guard-shaped regrown aneurysm under the clip (implanted for 35 years) at anterior communicating artery. (c) Schematic image of the regrown aneurysm. (d) Intraoperative photograph showing the old clip on the regrown aneurysm. (e) Three straight clips were applied to obliterate the aneurysm completely
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F3
SAH in the interhemispheric fissure, indicating rerupture of the previous aneurysm [Figure 3a]. Subsequent digital subtraction angiography revealed a gourd-shaped aneurysm with the old clip attached at its dome [Figure 3b and c]. Clearing the hematoma away from the clip, the aneurysm appeared in full view [Figure 3d]. Three straight clips were used to obliterate the aneurysm completely [Figure 3e].
(a and b) Photographs depicting the retrieved Sugita clip (No. 3, 07-940-03). (c and d) Scanning electron micrographs of the retrieved clip (left,x350, right, x750)
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F4
There was no severe damage or any corrosion of the clip [Figure 4a and b]. Careful observation of the clip surface with scanning electron microscope revealed no abnormality [Figure 4c and d].