Anterior Cerebral Artery (A1 Segment) Aneurysm: The eCLIPs Endovascular Clip System, a Novel Flow Diversion Approach to Managing Intracranial Aneurysms Arising from Arterial Bifurcations

Aneurysms arising from or adjacent to arterial bifurcations are challenging to treat and show a high recurrence rate after traditional endovascular treatment. The high prevalence and the unique structural and hemodynamic characteristics of aneurysms at arterial bifurcations call for dedicated treatment approaches. The endovascular clip system (eCLIPs, Evasc) is a novel device, which enables flow diversion away from the aneurysm sac and is shown to induce physiological remodeling with eventual sealing of the aneurysmal neck. We will discuss the application of eCLIPs for managing an anterior cerebral artery (ACA) aneurysm arising from the proximal A1 segment in a 49-year-old female patient. The medium-sized lobulated unruptured aneurysm adjacent to the right internal carotid artery (ICA) bifurcation was discovered incidentally and was treated with eCLIPs and coiling. Immediate flow stagnation in the aneurysm was observed after the uneventful deployment of eCLIPs. Loose coiling through eCLIPs was performed successfully with a small neck remnant. Follow-up after 6 months showed complete occlusion of the aneurysm. The use of eCLIPs is the main topic of this chapter.