The Sundt clip graft.

The Sundt clip graft is a vessel-encircling clip that can be used to repair a significant dehiscence or tear in an intracerebral vessel wall during urgent situations. This article analyzes the use of the Sundt clip in a variety of acute intraoperative situations. Under institutional review board (IRB) approval, a retrospective review of surgical records from 1988 to 2008 was conducted to identify patients in whom the clip graft was used. These patients' medical records and radiographic imaging studies were reviewed and analyzed. Seventeen patients were identified. A variety of vascular wall dehiscences were treated, including 9 with carotid aneurysm blisters. Other vessels repaired included the anterior choroidal artery (ACA), posterior communicating artery (PCA), and middle cerebral artery (MCA). Most were repaired with a 5-to 6-mm clip graft in varying lengths. Postoperative angiography was performed in 16 patients. In 14 patients, the vessel was preserved with a patency of 80% or greater. One patient had a 50% stenosis, and in another the vessel was occluded. The neurologic outcome was related to the underlying pathology and clinical presentation. Overall, 13 patients recovered with a Glasgow Outcome Score (GOS) of 5. Three patients did poorly, with a GOS of 3, and 1 patient died related to subarachnoid hemorrhage (SAH) vasospasm. Neurosurgeons should remember that the Sundt clip graft may be used in emergent situations in which a vascular tear or blister is encountered and the vessel cannot be repaired with suturing or other techniques, including standard encircling aneurysm clips.