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. 2022 Jul;164(7):1861-1871.
doi: 10.1007/s00701-022-05182-1. Epub 2022 May 7.

The Sutureless Excimer Laser Anastomosis Clip Pilot Study: a feasibility and safety study

Albert van der Zwan #  1 , Kiki Gortzak #  2 , Bart de Boer #  3 , Saskia Redegeld #  2 , Sander van Thoor #  2 , Cornelius Tulleken #  2
Affiliations

The Sutureless Excimer Laser Anastomosis Clip Pilot Study: a feasibility and safety study

Albert van der Zwan et al. Acta Neurochir (Wien). 2022 Jul.

Abstract

Background: The excimer laser-assisted non-occlusive anastomosis (ELANA) bypass technique may have the advantage of its non-occlusive design in the treatment of last-resort cases where endovascular treatment or direct clipping is considered to be unsafe. However, the technique remains technically challenging. Therefore, a sutureless ELANA Clip device (SEcl) was developed to simplify the technique avoiding tedious anastomosis stitching in depth. The present study investigates the clinical feasibility and safety of the SEcl technique.

Methods: Three patients with complex and large aneurysms in the anterior circulation were selected after multidisciplinary consensus that the aneurysms were too complex for endovascular or direct clipping treatment options. Bypass surgery was considered as a last-resort treatment option, and after preoperative evaluation and informed consent, SEcl bypass surgery was performed. Applicability, technical aspects and patient outcomes are assessed.

Results: All aneurysms were excluded from the circulation. The creation of the intracranial anastomosis was easier and faster. No device-related serious adverse events were encountered, and all outcomes were favorable (one patient stable Modified Rankin Scale, two patients improved).

Conclusion: The SEcl anastomosis technique is feasible and, considering the severity of the disease, relatively safe. It can be considered a treatment option in very difficult-to treat last-resort aneurysm cases. From this study, further developments in minimizing clip size and application in cardiac surgery are initiated.

Keywords: Anastomosis; Bypass; Clip; Non-occlusive Sutureless Technique.

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Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
a: Sutureless ELANA clip; b: sutureless ELANA clip with mounted vein; c: insertion into vessel; d: closure of clip; e: inserting laser catheter; f: lasering anastomosis; g: retrieval of catheter; h: retrieval of flap
Fig. 2
Fig. 2
Patient 1: 3D DSA of right-sided partially thrombosed internal carotid artery aneurysm
Fig. 3
Fig. 3
Patient 1: DSA showing complete left to right overflow after right ICA occlusion
Fig. 4
Fig. 4
Patient 2: DSA of growing right internal carotid artery aneurysm
Fig. 5
Fig. 5
Patient 2:DSA of SEcl high flow EC-IC bypass after occlusion of the right internal carotid artery. Figure 5 b: Proximal anastomosis on the external carotid artery (arrow). Figure 5 b: Distal anastomosis (SEcl) on the distal tight internal carotid artery (asterisk)
Fig. 6
Fig. 6
Patient 3: a: DSA of partially thrombosed of aneurysm of right internal carotid artery b: CTA
Fig. 7
Fig. 7
a: DSA of SEcl high flow EC-IC bypass after occlusion of the right internal carotid artery. Proximal anastomosis on the external carotid artery (arrow). Distal anastomosis (SEcl) on the middle cerebral artery (asterisk) b: Detail of distal anastomosis with clip in situ (asterisk)
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