Use of an extrasaccular flow diverter, eCLIPs eBFD, to treat a wide-neck bifurcation aneurysm (WNBA) in a patient requiring long-term anticoagulation

Wide neck bifurcation aneurysms are treated by intrasaccular implants, stent-assisted coiling, or flow diverters (FDs). The latter two options require long-term dual anti-platelet agents (DAPTs) and the former require access to the vulnerable aneurysm dome.^{1- 5} In patients requiring oral anticoagulation (OAC), an alternative treatment strategy would be advantageous to mitigate the foregoing risks. This report describes using a dedicated bifurcation FD, eCLIPs eBFD, to treat a basilar tip bifurcation aneurysm in a patient with atrial fibrillation requiring long-term OACs. The non-tubular eBFD aneurysm neck-bridging implant provides coil-retaining and flow diverting features and serves as a platform for endothelial growth.^{6, 7} It has shown flow velocity reduction at a bifurcation equivalent to a tubular FD at a sidewall.⁸ In this case, eBFD, without coils, resulted in protracted intrasaccular stasis and resulted in complete aneurysm occlusion and neck remodeling within three months of discontinuation of dual anti-platelet therapy, without interrupting OAC.