Glue-Enhanced Excimer Laser-Assisted Nonocclusive Anastomosis: A Laboratory Investigation

Abstract

Background/Aims: The excimer laser-assisted nonocclusive anastomosis (ELANA) technique has been developed as a clinical effective technique to perform intracranial high-flow bypass without temporary occlusion of cerebral vessels in otherwise untreatable or high-risk cerebrovascular diseases. We experimentally tested the application of a nonabsorbable cyanoacrylate-based sealant with the ELANA technique. Methods: Three technical in vitro variations of the ELANA anastomosis technique using Omnex^© glue and expanded polytetrafluoroethylene tube were compared with conventional sutured ELANA bypasses, resulting in 36 bypasses and 72 anastomoses. After that, the best resulting type was tested in 10 rabbits. Results: The ELANA bypass using Omnex and the expanded polytetrafluoroethylene tube technique offers better results in vitro in the retrieval of the arterial wall flap after arteriotomy, is faster, and the tensile strength of the bypasses performed with Omnex is comparable with those performed with conventional sutures. However, in 2 cases, we observed thrombosis of the vessel and considerable stiffness. Conclusions: The combining of the ELANA technique with 2-octyl cyanoacrylate and butyl lactoyl cyanoacrylate experimentally provides some advantages over the conventional ELANA technique. Further experimental studies should be performed in order to improve the safety and applicability of this technique.