Techniques and long-term outcomes of Y-shaped autologous dura mater wrap-clipping of blood blister-like aneurysms

The optimal surgical strategy for treating internal carotid artery (ICA) blood blister-like aneurysms (BBAs) has remained unclear. Wrap-clipping is one of the recommended treatments for BBAs, but the long-term clinical and angiographic outcomes of this procedure have not yet been elucidated. Here, we report the technical details and long-term outcomes of wrap-clipping with Y-shaped autologous dura mater of BBAs.Data from 28 patients with BBAs treated at our institute from 1997 to 2021 were retrospectively analyzed. Twenty-one patients successfully underwent wrap-clipping with dura mater, and seven patients underwent other microsurgery methods. Clinical outcomes were assessed using the modified Rankin Scale (mRS).Twenty-one patients had a good outcome with a mRS of 1 or 2; four patients had a poor outcome with a mRS of 3 or 4; and three patients died. There was no rerupture or regrowth of a BBA, and no symptomatic stenosis of the ICA was observed in wrap-clipping with dura mater patients.Wrap-clipping with autologous dura mater for BBAs is a valuable and convenient procedure with long-term effectiveness. When BBAs are located at the contralateral side of the origin of the main branching vessels, the Y shape can prevent compression of the branching vessels.