Abstract
BackgroundHigh 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.MethodsA 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.ResultsThe 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.ConclusionThe 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.
Highlights
High flow bypass surgery can be a last resort procedure for patients suffering from complex neurovascular pathology
The mean SELANA clip (SEcl) application time was 15.2 ± 9.6 min for the 37 anastomoses This was significantly faster (p < 0.0001, Table 1) than the conventional ELANA anastomosis described by Streefkerk et al [6], with mean difference of 30.0 min
The flap was not retrieved by the catheter in 5 anastomoses and was manually extracted in all these procedures by either opening of the SEcl or performing a longitudinal incision in the donor
Summary
High flow bypass surgery can be a last resort procedure for patients suffering from complex neurovascular pathology. The ELANA arteriotomy system is intended to create an intracranial anastomosis in a non-occlusive manner. 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 anastomosis to be completed. Mechanical anastomotic connection device, the SELANA clip (Sutureless Excimer Laser-Assisted Non-occlusive Anastomosis clip: SEcl). Flap retrieval rates, hemostasis, patency, flow, endothelialization, and remodeling were assessed
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