INR scope

Bridging the neck: eCLIPS for a previously ruptured middle cerebral artery aneurysm

Author: DIESTRO Jose Danielo B

Find out how Dr. Jose Danilo B. Diestro (St. Michael’s Hospital, University of Toronto, Department of Medical Imaging Toronto, Canada) treated a 61-year-old male patient suffering from a ruptured middle cerebral artery aneurysm.

Monday 14 March 2022
  • Case

    CASE PRESENTATION

    • Initial measurement 9mm x 5mm x 6mm, with murphy’s teat and a neck of 3mm
    • Angio 8mm on maximal diameter
    • 4mm to 7mm filling remnant on MRI July to October.      
    • February post-treatment 3mm remnant   
    • Also with pericallosal and acomm complex aneurysm
    eCLIPS

     

    INITIAL NEUROIMAGING: 07-2019

    eCLIPS

     

    ENDOVASCULAR REPAIR: 07-2019

    • 2 coils placed
    • 6mm by 26mm Cosmos Microplex
    • 6mm by 6mm Hypersoft Helical

     

    eCLIPS

     

    PRE AND POST REPAIR IMAGING

    • MRI done a day after: 4mm remnant from previous 5mm

     

    eCLIPS

     

    RECURRENCE: JULY TO OCTOBER 2019

    • 4mm to 7mm remnant

     

    eCLIPS

     

    ENDOVASCULAR REPAIR: 2-2020

    • Red arrow on larger M2 branch measuring 2mm in width

     

    eCLIPS

     

    eCLIPS DEVICE

     

    eCLIPS

     

    eCLIPS

     

    eCLIPS + COILS: BILATERAL GROIN ACCESS

    • Two Vascular Access PointsRight: 6F x 80 cm Shuttle + 0.072 x 105cm
    • Navien Intermediate Catheter + Headway 27 Microcatheter + eCLIPS device
    • Left: 5F x 11 cm Femoral sheath + 5F x 100cm Envoy catheter + Headway 17 microcatheter + Coils

     

     

    ENDOVASCULAR REPAIR PLAN

    • Secure the neck
      • Deploy the eCLIPS through the Headway 27 in the inferior M2 branch and across the neck of the aneurysm
    • Coil the residual
      • Coil the residual portion of the aneurysm by crossing the eCLIPS leaf with the Headway 17

         

    eCLIPS

     

    eCLIPS POSITIONING

     

    eCLIPS

     

    COILING THROUGH eCLIPS

    • 5mM x 15 helis
    • 3mm x 4cm helix
    • 3mm x 4cm helix
    • 2.5mm x 3cm
    • 2.5mm x 3cm
    • 2.5mm x 6cm
    • 2.5mm x 4cm
    • ALL HELIX

     

    eCLIPS

     

    PRE AND POST REPAIR IMAGING

    • MRI one day after recoiling: 3mm remnant

       

    eCLIPS

     

    PHYSIOLOGIC REMODELING

     

    eCLIPS

     

    eCLIPS 14

     

    eCLIPS

     

    CLINICAL OUTCOMES

    • 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 non-deployment 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.

     

    eCLIPS

     

    eCLIPS

     

    POINTS FOR DISCUSSION

    • Clipping on initial presentation? 
    • Would other devices have gotten better results?
    • What are the properties of the eCLIPS device that make it unique?
    • What aneurysm characteristics make it suitable for the eCLIPS device?

     

    ENDOVASCULAR FIRST FOR RUPTURED MCAs

     

    eCLIPS

     

    ONGOING TRIALS: EESIS

     

    eCLIPS
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