Minimally-Invasive Bypass kit Makes Cerebral Surgery Safer

A pioneering anastomosis kit constructs a cerebral vascular bypass without interruption of the blood flow, in patients who have an aneurysm or tumor at the base of the skull.

The ELANA surgical kit, which is comprised of platinum rings, an excimer laser catheter, a luer-lock, and clips, is intended for use in anastomosis construction using the Excimer Laser Assisted Non-occlusive Anastomosis (ELANA) technique, which creates an end-to-side (T-shaped) anastomosis without temporary closing of the recipient artery. This is an important feature in bypass surgery, since it facilitates the creation of anastomoses in vessels that were previously considered impossible to perform with conventional anastomosis techniques, such as in a cerebral artery.


The technique involves several stages, the first being the stitching of a platinum ring to the donor vessel. The surgeon then stitches the donor vessel with the Elana Ring to the recipient artery, which is never occluded during the procedure. Subsequently, a vacuum suction pump sucks the wall of the recipient vessel against the grid of a proprietary hollow catheter that channels the laser. Using the laser light, the catheter cuts a round hole in the wall of the main vessel; the sutured platinum ring ensures the catheter sits in place and does not penetrate the vessel. The disk of cut out tissue, which is vacuum-held by the catheter tip, is then carefully retrieved.

At this stage, the donor vessel is temporarily occluded with a clip; finally, a proximal, extracranial anastomosis is connected the temporal artery (STA). This is done by conventional means since patients tolerate temporary occlusion time in these regions. The two donor grafts are then connected with sutures, and the temporary clips on the donor vessels are removed; the surgeon can then treat disease, for example taking out the aneurysm or tumor from the circulation. The ELANA surgical kit is a product of Elana (Utrecht, The Netherlands).

During the construction of a conventional anastomosis, it is necessary to occlude a recipient artery for 10 minutes up to 45 minutes, depending on the place of the anastomosis, notwithstanding extension of this time due to complications. In case of conventional anastomosis grafting in the brain, this temporary occlusion may well lead to an ischemic event, since brain cells are very vulnerable to a lack of oxygen supply via the blood flow.

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