eCLIPs treatment of intrasaccular device recurrences in wide neck bifurcation aneurysms: multicenter experience with the new generation device

Abstract

Background and objectives: Intracranial wide neck bifurcation aneurysms treated with intrasaccular devices can have recurrences, with adverse morphologies, that are challenging to manage. We report our initial experience of the latest generation endovascular clip system (eCLIPs) (eVasc, Vancouver, British Columbia, Canada) device in treating these complex lesions.

Methods: A prospectively maintained registry was reviewed for patients that were initially treated with a Woven EndoBridge (WEB) (Microvention, Aliso Viejo, California, USA), Contour (Cerus Endovascular, Fremont, California, USA), or Artisse (Medtronic, Irvine, California, USA) intrasaccular device, and subsequently underwent retreatment with an eCLIPs implant. The following data were analyzed: aneurysm location, recurrence dimensions, dome-to-neck and aspect ratios, rupture status, procedural time metrics, complications, anti-platelet medication, baseline and 6 month modified Rankin Scores (mRS), angiographic outcome and follow-up using modified Raymond-Roy Occlusion Classification (mRROC).

Results: Twenty-one aneurysm recurrences across 21 patients were treated between October 2022 and December 2024. eCLIPs was successfully deployed in all cases intended for retreatment with the device. Primary treatment was performed using a WEB (n=14), Contour (n=5) or Artisse device (n=2). The median aneurysm recurrence size was 7.0 mm (range: 2.1 mm-10.3 mm). The median aspect ratio was 0.87 (range: 0.50-2.24) and the median dome-to-neck ratio 1.16 (range: 0.53-1.69). Of the 13 patients with available follow-up (median duration=11 months), all had adequate occlusion (10 were mRROC=1, and three were mRROC=2). There were no device related safety events.

Conclusion: The new generation eCLIPs can be used safely and with a high rate of technical success for a range of bifurcation aneurysm recurrences initially treated with an intrasaccular device. While treatment durability appears promising, further long-term prospective studies are needed to confirm these findings.

Keywords: Aneurysm; Device; Flow Diverter; Stent; Technique.