The second-generation eCLIPs Endovascular Clip System: initial experience

Albert H. Chiu Neurovascular Program,
Department of Medical Imaging, University of Toronto, Ontario;
Division of Neurosurgery,

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 MBBS, FRANZCR
,
Joost De Vries Radboud University Nijmegen, The Netherlands; and

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 MD, PhD
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Cian J. O'Kelly Division of Neurosurgery, University of Alberta, Calgary, Alberta; and

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 MD, MSc, FRCSC
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Howard Riina Department of Neurosurgery, NYU School of Medicine, NYU Langone Medical Center, New York, New York

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 MD
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Ian McDougall Evasc Medical Systems Corporation, Vancouver, British Columbia, Canada;

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 BASc
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Jonathan Tippett Evasc Medical Systems Corporation, Vancouver, British Columbia, Canada;

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 BASc
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Martina Wan Evasc Medical Systems Corporation, Vancouver, British Columbia, Canada;

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 PEng, BASc
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Airton Leonardo de Oliveira Manoel Keenan Research Centre, Li Ka Shing Knowledge Institute, and

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 MD
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Thomas R. Marotta Department of Medical Imaging, University of Toronto, Ontario;
Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto;

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OBJECTIVE

Treatment of wide-necked intracranial aneurysms is associated with higher recanalization and complication rates; however, the most commonly used methods are not specifically designed to work in bifurcation lesions. To address these issues, the authors describe the evolution in the design and use of the eCLIPs (Endovascular Clip System) device, a novel hybrid stent-like assist device with flow diverter properties that was first described in 2008.

METHODS

A registry was established covering 13 international centers at which patients were treated with the second-generation eCLIPs device. Aneurysm morphology and rupture status, device neck coverage, coil retention, and procedural and late morbidity and mortality were recorded. For those patients who had undergone successful implantation more than 6 months earlier, the final imaging and clinical follow-up results and need for re-treatment were recorded.

RESULTS

Thirty-three patients were treated between June 2013 and September 2015. Twenty-five (76%) patients had successful placement of an eCLIPs device; 23 (92%) of these 25 patients had complete data. Eight cases of nondeployment occurred during the 1st year of use, consistent with a learning curve; no failures of deployment occurred thereafter. Two periprocedural transient ischemic attacks and 2 asymptomatic thrombotic events occurred. Twenty-one (91%) of 23 patients underwent follow-up at an average of 8 months (range 3–18 months); 9 (42.9%) of these 21 patients demonstrated an improvement in Raymond grade at follow-up; no cases of worsening Raymond grade were recorded, and 17 (81.0%) patients sustained a modified Raymond-Roy Classification class of I or II angiographic result at follow-up. Two delayed ruptures were recorded, both in previously coiled, symptomatic giant aneurysms where the device was used as a part of a salvage strategy.

CONCLUSIONS

The second-generation eCLIPs device is a viable treatment option for bifurcation aneurysms. The aneurysm occlusion rates in this initial clinical series are comparable to the initial experience with other bifurcation support devices.

ABBREVIATIONS

ICA = internal carotid artery; MCA = middle cerebral artery; MRRC = modified Raymond-Roy Classification; PCA = posterior cerebral artery; WEB = Woven EndoBridge Aneurysm Embolization System.
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  • 1

    Aguilar-Pérez M, Kurre W, Fischer S, Bäzner H, Henkes H: Coil occlusion of wide-neck bifurcation aneurysms assisted by a novel intra- to extra-aneurysmatic neck-bridging device (pCONus): initial experience. AJNR Am J Neuroradiol 35:965971, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Chow MM, Woo HH, Masaryk TJ, Rasmussen PA: A novel endovascular treatment of a wide-necked basilar apex aneurysm by using a Y-configuration, double-stent technique. AJNR Am J Neuroradiol 25:509512, 2004

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Cognard C, Januel AC: Remnants and recurrences after the use of the WEB intrasaccular device in large-neck bifurcation aneurysms. Neurosurgery 76:522530, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Gory B, Aguilar-Pérez M, Pomero E, Turjman F, Weber W, Fischer S, et al.: pCONus device for the endovascular treatment of wide-neck middle cerebral artery aneurysms. AJNR Am J Neuroradiol 36:17351740, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Henkes H, Fischer S, Weber W, Miloslavski E, Felber S, Brew S, et al.: Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 54:268285, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Hetts SW, Turk A, English JD, Dowd CF, Mocco J, Prestigiacomo C, et al.: Stent-assisted coiling versus coiling alone in unruptured intracranial aneurysms in the matrix and platinum science trial: safety, efficacy, and mid-term outcomes. AJNR Am J Neuroradiol 35:698705, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Hope JK, Byrne JV, Molyneux AJ: Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization. AJNR Am J Neuroradiol 20:391399, 1999

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Jahshan S, Abla AA, Natarajan SK, Drummond PS, Kan P, Karmon Y, et al.: Results of stent-assisted vs non-stent-assisted endovascular therapies in 489 cerebral aneurysms: single-center experience. Neurosurgery 72:232239, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Kulcsár Z, Houdart E, Bonafé A, Parker G, Millar J, Goddard AJ, et al.: Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32:2025, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Marotta TR, Gunnarsson T, Penn I, Ricci DR, McDougall I, Marko A, et al.: A novel endovascular clip system for the treatment of intracranial aneurysms: technology, concept, and initial experimental results. Laboratory investigation. J Neurosurg 108:12301240, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Marotta TR, Riina HA, McDougall I, Ricci DR, Killer-Oberpfalzer M: Physiological remodeling of bifurcation aneurysms: preclinical results of the eCLIPs device. J Neurosurg [epub ahead of print March 17, 2017. DOI: 10.3171/201610.JNS162024]

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Mascitelli JR, Moyle H, Oermann EK, Polykarpou MF, Patel AA, Doshi AH, et al.: An update to the Raymond-Roy Occlusion Classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg 7:496502, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Pierot L, Cognard C, Spelle L, Moret J: Safety and efficacy of balloon remodeling technique during endovascular treatment of intracranial aneurysms: critical review of the literature. AJNR Am J Neuroradiol 33:1215, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Pierot L, Liebig T, Sychra V, Kadziolka K, Dorn F, Strasilla C, et al.: Intrasaccular flow-disruption treatment of intracranial aneurysms: preliminary results of a multicenter clinical study. AJNR Am J Neuroradiol 33:12321238, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Spiotta AM, Lena J, Chaudry MI, Turner RD, Turk AS: Y-stenting for bifurcation aneurysm coil embolization: what is the risk?. Stroke Res Treat 2014:762389, 2014

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Yang H, Sun Y, Jiang Y, Lv X, Zhao Y, Li Y, et al.: Comparison of stent-assisted coiling vs coiling alone in 563 intracranial aneurysms: safety and efficacy at a high-volume center. Neurosurgery 77:241247, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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