The Sutureless Excimer Laser Anastomosis Clip Pilot Study: a feasibility and safety study

Albert van der Zwan*, Kiki Gortzak, Bart de Boer, Saskia Redegeld, Sander van Thoor, Cornelius Tulleken

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: The excimer laser-assisted non-occlusive anastomosis (ELANA) bypass technique may have the advantage of its non-occlusive design in the treatment of last-resort cases where endovascular treatment or direct clipping is considered to be unsafe. However, the technique remains technically challenging. Therefore, a sutureless ELANA Clip device (SEcl) was developed to simplify the technique avoiding tedious anastomosis stitching in depth. The present study investigates the clinical feasibility and safety of the SEcl technique. Methods: Three patients with complex and large aneurysms in the anterior circulation were selected after multidisciplinary consensus that the aneurysms were too complex for endovascular or direct clipping treatment options. Bypass surgery was considered as a last-resort treatment option, and after preoperative evaluation and informed consent, SEcl bypass surgery was performed. Applicability, technical aspects and patient outcomes are assessed. Results: All aneurysms were excluded from the circulation. The creation of the intracranial anastomosis was easier and faster. No device-related serious adverse events were encountered, and all outcomes were favorable (one patient stable Modified Rankin Scale, two patients improved). Conclusion: The SEcl anastomosis technique is feasible and, considering the severity of the disease, relatively safe. It can be considered a treatment option in very difficult-to treat last-resort aneurysm cases. From this study, further developments in minimizing clip size and application in cardiac surgery are initiated.

Original languageEnglish
Pages (from-to)1861-1871
Number of pages11
JournalActa Neurochirurgica
Issue number7
Publication statusPublished - Jul 2022


  • Anastomosis, Surgical/methods
  • Aneurysm
  • Cerebral Revascularization/methods
  • Feasibility Studies
  • Humans
  • Intracranial Aneurysm/diagnostic imaging
  • Lasers, Excimer/therapeutic use
  • Pilot Projects
  • Surgical Instruments
  • Treatment Outcome
  • Anastomosis
  • Non-occlusive Sutureless Technique
  • Clip
  • Bypass


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