Saura et al., report a case of ruptured postero-medially projecting internal carotid artery aneurysm treated using a right-angled fenestrated T bar clip (Yasargil titanium clip). A 52-year-old woman was admitted to our hospital with severe headache. Three-dimensional computed tomography angiography showed a saccular aneurysm arising from the left, unusually short ICA, located proximal to the anterior choroidal artery. The right-angled fenestrated T-bar clip (blade length, 5 mm) was applied across the ICA, followed by reconstruction of the ICA wall with preservation of the anterior choroidal artery and simultaneous obliteration of the aneurysm. The key characteristic of the fenestrated T-bar clip is that the fenestrated portion of the clip is connected to the center of the blades. The tips of the blades on both sides are thus clearly visible during clip application.
Application of the T-bar clip allows the surgeon to perform clip ligation of a postero-medially projecting ICA aneurysm while preserving the adjacent perforating artery 1).