Long-term feasibility of the new sutureless excimer laser-assisted non-occlusive anastomosis clip in a pig model
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - OTHER
Long-term feasibility of the new sutureless excimer laser-assisted non-occlusive anastomosis clip in a pig model B. de Boer 1,2
&
T. P. C. van Doormaal 1,2,3 & C. A. F. Tulleken 2 & L. Regli 3 & A. van der Zwan 1,2
Received: 22 June 2020 / Accepted: 10 August 2020 # The Author(s) 2020
Abstract Background High flow bypass surgery can be a last resort procedure for patients suffering from complex neurovascular pathology. Temporary occlusion of a recipient artery in these patients could result in debilitating neurological deficits. We developed a sutureless, mechanical anastomotic connection device, the SELANA clip (Sutureless Excimer Laser-Assisted Non-occlusive Anastomosis clip: SEcl). In the present study, we aim to determine the long-term non-inferiority of the SEcl technique compared with historical data of the conventional ELANA anastomosis technique. Methods A total of 18 SEcl bypasses were created on the carotid artery in a porcine model in 6 different survival groups. Mean application times, flap retrieval rates, hemostasis, patency, flow, endothelialization, and remodeling were assessed. Results The mean application time of the SEcl anastomoses was 15.2 ± 9.6 min, which was faster compared with the conventional ELANA anastomoses. The flap retrieval rate of the SEcl anastomoses was 86% (32/37). Direct hemostasis was achieved in 89% (33/37) SEcl anastomoses. Patency in all surviving animals was 94% (17/18). Bypass flow after six months was 156.5 ± 24.7 mL/min. Full endothelialization of the SEcl pins was observed after 3 weeks. Conclusion The SEcl technique is not inferior to the ELANA technique regarding patency, flap retrieval rate, flow, and endothelialization. On the basis of a significantly shorter application time and superior hemostasis, the SEcl technique could be preferable over the ELANA technique. A pilot study in patients is a logical next step based on our current results. Keywords Cerebral revascularization . Non-occlusive . Anastomosis . Device
Introduction High flow bypass surgery can be a last resort procedure for patients suffering from complex neurovascular pathology. Temporary occlusion of a large recipient artery in these patients could result in debilitating neurological deficits. The ELANA arteriotomy system is intended to create an intracranial anastomosis in a non-occlusive manner. It requires This article is part of the Tropical Collection on Vascular Neurosurgery—Other * B. de Boer [email protected] 1
Brain Center Rudolph Magnus, Department of Neurosurgery, UMC Utrecht, Heidelberglaan 100, G.03.124, 3584 CX Utrecht, The Netherlands
2
Brain Technology Institute, Utrecht, The Netherlands
3
Department of Neurosurgery, Universitätsspital Zürich, Zurich, Switzerland
considerable skills form the neurosurgeon to connect the donor graft to the recipient vessel with micro sutures, most often at the intracranial ICA [7, 8]. This procedure, even in experienced hands, is time consuming and takes a minimum of 60 min for each anas
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