Anterior Cerebral Artery (A1 Segment) Aneurysm: The eCLIPs Endovascular Clip System, a Novel Flow Diversion Approach to Managing Intracranial Aneurysms Arising from Arterial Bifurcations
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365体育网站Aneurysms arising from or adjacent to arterial bifurcations are challenging to treat and show a high recurrence rate after traditional endovascular treatment. The high prevalence and the unique structural and hemodynamic characteristics of aneurysms at arterial bifurcations call for dedicated treatment approaches. The endovascular clip system (eCLIPs, Evasc) is a novel device, which enables flow diversion away from the aneurysm sac and is shown to induce physiological remodeling with eventual sealing of the aneurysmal neck. We will discuss the application of eCLIPs for managing an anterior cerebral artery (ACA) aneurysm arising from the proximal A1 segment in a 49-year-old female patient. The medium-sized lobulated unruptured aneurysm adjacent to the right internal carotid artery (ICA) bifurcation was discovered incidentally and was treated with eCLIPs and coiling. Immediate flow stagnation in the aneurysm was observed after the uneventful deployment of eCLIPs. Loose coiling through eCLIPs was performed successfully with a small neck remnant. Follow-up after 6 months showed complete occlusion of the aneurysm. The use of eCLIPs is the main topic of this chapter.
KeywordsAnterior cerebral artery Internal carotid artery bifurcation Flow diversion Bifurcation aneurysm Coils eCLIPs
- Baxter BW, Rosso D, Lownie SP. Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR Am J Neuroradiol. 1998;19(6):1176–8.
- Chiu AH, De Vries J, O’Kelly CJ, Riina H, McDougall I, Tippett J, Wan M, de Oliveira Manoel AL, Marotta TR. The second-generation eCLIPs endovascular clip system: initial experience. J Neurosurg. 2018;128(2):482–9. .
- Cho YD, Rhim JK, Kang HS, Park JJ, Jeon JP, Kim JE, Cho WS, Han MH. Use of triple microcatheters for endovascular treatment of wide-necked intracranial aneurysms: a single center experience. Korean J Radiol. 2015;16(5):1109–18. .
- Henkes H, Weber W. The past, present and future of endovascular aneurysm treatment. Clin Neuroradiol. 2015;25(Suppl 2):317–24. .
- Marotta TR, Riina HA, McDougall I, Ricci DR. Killer-Oberpfalzer M. physiological remodeling of bifurcation aneurysms: preclinical results of the eCLIPs device. J Neurosurg. 2018;128(2):475–81. .
- O’Kelly CJ, Krings T, Fiorella D. Marotta TR. A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents. Interv Neuroradiol. 2010;16(2):133–7.
- Padalino DJ, Singla A, Jacobsen W, Deshaies EM. Enterprise stent for waffle-cone stent-assisted coil embolization of large wide-necked arterial bifurcation aneurysms. Surg Neurol Int. 2013;4:9. .
- Pierot L, Wakhloo AK. Endovascular treatment of intracranial aneurysms: current status. Stroke. 2013;44(7):2046–54. .
- Ricci DR, de Vries J, Blanc R. Role of preliminary registry data in development of a clinical trial for an innovative device: a small but integral piece of a health policy initiative. J Mark Access Health Policy. 2017;5(1):1283106. .