Particle Image Velocimetry Measurements of the Flow-Diverting Effects of a New Generation of the eCLIPs Implant for the Treatment of Intracranial Bifurcation Aneurysms

Abstract

Flow diverters (FDs) for the endovascular treatment of intracranial aneurysms are effective for sidewall aneurysms, but their use at a bifurcation is problematic because FDs only partially cover the aneurysm neck and impede flow into a daughter branch; they are thus not employed routinely in this anatomy. eCLIPs was developed as a non-tubular implant to completely cover the neck of an aneurysm and serve as a coil retention device necessary for the adequate treatment of wide-neck bifurcation aneurysms. eCLIPs has shown some flow diversion effects in bifurcation anatomy but not equal to those exhibited by clinically accepted flow diverters in sidewall anatomy. A new generation of eCLIPs implant, the eCLIPs bifurcation flow diverter (eBFD), with higher metal coverage, was developed to achieve a similar flow diversion as a Pipeline Embolization Device (PED), a prototypical FD. Particle image velocimetry was used to capture the fluid dynamics and velocity reduction within silicone aneurysm replicas. A circulatory mimicking loop was developed to circulate the flow through the silicone models. All generations of eCLIPs implants had some flow-diverting effect, with increasing metal coverage density of the implant proportionately increasing the flow diversion effect. The eBFD, with a metal density of 35%, showed greater flow diversion than PED, with 30% metal density, for bifurcation anatomy. The eBFD showed similar reduction of flow in a bifurcation anatomy to PED in a sidewall, both sufficient to permit early thrombosis of the aneurysm. Thus, the eBFD can potentially provide sufficient flow diversion for the treatment of bifurcation aneurysms to avoid adjunctive coiling.