A Slippery Slope: Taking a Look at Post-Operative Aneurysm Clip Slippagetext_resourcesBackground: Post-operative clip slippage is a rare complication of aneurysm clipping that can lead to aneurysm recurrence or rupture. This paper aims to systematically review the current literature to understand the current impact and explore causative factors of clip slippage. Method: A comprehensive search was conducted through major databases and grey literature for studies published within 30 years assessing clip slippage. Studies were included if they described post-operative clip malposition. Studies that described only intra-operative slippage, lacked sufficient data, and case reports were excluded. Five articles met inclusion criteria and underwent systematic review. Aggregated case analysis was conducted using R Studio. Results: A total of 3374 patients underwent clipping across the five studies, ranging between 38-76 years. Twelve aneurysms had radiographically confirmed post-operative clip slippage. The majority of slippages were located in the anterior communicating artery (N=6), followed by the middle cerebral artery (N=4). The most common aneurysm size was medium (5-10mm; N=4), followed by large (10-25mm; N=3), small (<5mm; N=2), and giant (>25mm; N=1); two aneurysms were of indeterminate size. Five slippages were caught within one month of clipping, and a further two were identified within one year. There was no significant association between aneurysm size and the discovery time-frame (Cramer’s V: 0.67, P=0.47), or between aneurysm location and time-frame (Cramer’s V: 0.52, P=0.63). Conclusion: Post-operative clip slippage is a rare but dangerous complication. Unexpectedly, there were no documented slipped clips of basilar aneurysms despite their complexity and the volume of blood flow through the vessel. There were no robust associations between aneurysm size or location with detection time-frame. This study is limited by the small number of reported slippages outside of case reports. Additional case series would be ideal to further the understanding of clip slippage.Tziviskos, NassosAuthorGreco, ShayAuthorShin, Sue MinAuthorSuo, Nan JiAuthor2025aneurysmreinterventioncerebrovascularclipcomplicationslippagepostersAll rights reservedIn CopyrightAll Rights Reserved10.26300/dqnf-g131