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2019 | 2 | 1 | 56-69
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Late postoperative slippage of the cerebral aneurysm clip. A systematic review and meta-analysis

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Background A late clip slippage from the previously properly secured cerebral aneurysm is rarely observed. To date these complications have not pooled and evaluated using systematic review methodology. The objective was to report factors attributed to the late slippage of the aneurysm clip in the postoperative period. Material and methods All causes of postoperative clip slippage were systematically reviewed and analysed according to PRISMA Individual Patient Data protocol. Medline (PubMed), Embase, Cochrane, ISI Web of Knowledge and Google Scholar were searched for all relevant cases. Results Systematic review of the literature yielded 105 original cases proving slipped clip in the postoperative period. The slipped clip caused bleeding in 53.8% of patients. The putative cause of clip slippage was provided in only 34.7% of the published cases. If a single clip was used, then complete clip slippage was noted more often (p=0.04). Multiple clipping and clip-wrapping techniques were postulated as ways to prevent postoperative clip slippage. Conclusions The reason for late slippage of the aneurysm clip remains unexplained by most authors. Based on systematic reviewing, the use of tandem of clips prevents their late migration off the aneurysm. Clipping with wrapping or use of a single clip reinforced by any wrapping material seems a more durable solution.
Physical description
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