“The zipper technique”—a zip/unzip manoeuvre for thrombectomy in a giant coiled thrombotic aneurysm – how i do it

Background

In GTA, exposing the neck is challenging, and temporary clipping is often not feasible, increasing the risk of intraoperative bleeding.

Method

An aneurysmotomy with a continuous lock on one side and a clip on the other is performed and functions as a "zipper." During thrombectomy, if bleeding occurs, the zipper closes for temporary clipping. A clinical case demonstrates this technique.

Conclusion

The 'zipper' technique is a novel approach that offers the potential benefit of performing thrombectomy without requiring proximal control. Moreover, it may reduce the overall duration of temporary clipping by breaking it down into shorter intervals. However, this is a proof of concept demonstrated in a single case, and further validation through additional cases is necessary to confirm its efficacy.