title: The second-generation eCLIPs Endovascular Clip System: initial experience.
abstract: 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.
authors.affiliation: 1Neurovascular Program.|2Department of Medical Imaging, University of Toronto, Ontario.|3Division of Neurosurgery.
authors.forename: Albert H
authors.initials: AH
authors.lastname: Chiu
authors.affiliation: 4Radboud University Nijmegen, TheNetherlands; and.
authors.forename: Joost
authors.initials: J
authors.lastname: De Vries
authors.affiliation: 5Division of Neurosurgery, University of Alberta, Calgary, Alberta; and.
authors.forename: Cian J
authors.initials: CJ
authors.lastname: O'Kelly
authors.affiliation: 6Department of Neurosurgery, NYU School of Medicine, NYU Langone Medical Center, New York, New York.
authors.forename: Howard
authors.initials: H
authors.lastname: Riina
authors.affiliation: 7Evasc Medical Systems Corporation, Vancouver, British Columbia,Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: McDougall
authors.affiliation: 7Evasc Medical Systems Corporation, Vancouver, British Columbia,Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tippett
authors.affiliation: 7Evasc Medical Systems Corporation, Vancouver, British Columbia,Canada.
authors.forename: Martina
authors.initials: M
authors.lastname: Wan
authors.affiliation: 8Keenan Research Centre, Li Ka Shing Knowledge Institute, and.
authors.forename: Airton Leonardo
authors.initials: AL
authors.lastname: de Oliveira Manoel
authors.affiliation: 2Department of Medical Imaging, University of Toronto, Ontario.|9Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Marotta
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D000925:Anticoagulants / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: ICA = internal carotid artery; MCA = middle cerebral artery; MRRC = modified Raymond-Roy Classification; PCA = posterior cerebral artery; WEB = Woven EndoBridge Aneurysm Embolization System; bifurcation aneurysm; embolization; flow diversion; interventional neuroradiology; interventional neurosurgery; intracranial aneurysm; radiology; therapeutic; vascular disorders