The ETCHES I Study (Endovascular Treatment of Communicating Hydrocephalus With an Endovascular Shunt)

Study Overview
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Brief Summary
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The eShunt™ System is a minimally invasive method of treating communicating hydrocephalus. The eShunt System includes a proprietary eShunt Delivery System and the eShunt Implant, a permanent implant deployed in a minimally invasive, neuro-interventional procedure. The eShunt Implant is designed to drain excess cerebrospinal fluid (CSF) from the intracranial subarachnoid space (SAS) into the venous system.

Detailed Description
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This is a prospective, single-center, open label, single-arm pilot study of the eShunt System. The study population consists of patients with post-aneurysmal subarachnoid hemorrhage (SAH) treated for increased intracranial pressure (ICP) resulting in symptomatic hydrocephalus using an external ventricular drain (EVD) to facilitate CSF drainage and who cannot be weaned from the EVD following the hemorrhagic event. The study will be performed a single site with up to 30 subjects who meet the inclusion and exclusion criteria for the study. Subjects will be evaluated every 30 days for the first 90 days following eShunt Implant deployment with standard neurological evaluation appropriate for patients with communicating hydrocephalus. In addition, follow-up will occur at 180 days, 12 and 24 months post-operatively and will include imaging in addition to the standard neurological evaluation.

Official Title
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Pilot Study to Evaluate the Safety and Effectiveness of the CereVasc eShunt™ System in the Treatment of Communicating Hydrocephalus

Conditions
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Hydrocephalus, Communicating, Hydrocephalus

Intervention / Treatment
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* Device: eShunt™ Implant


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 Subject provides Informed Consent (IC) Post-aneurysmal SAH with Hunt and Hess Grades I-IV with EVD in place with the need for a permanent CSF shunt determined through a failed EVD clamping trial defined as: Post-clamping ICP of > 20 cmH2O for 15 min, or Post-clamping ICP > 25 cmH2O for < 15 min with patient intolerance to EVD clamping Post-clamping ICP >15 cmH2O for 15 min with radiographic evidence of ventriculomegaly Clinical signs and symptoms of communicating hydrocephalus Neurologically stable without evidence of severe vasospasm Pre-procedure MRI with gadolinium confirmation of IPS (inferior petrosal sinus) and CPA (cerebellopontine angle) cistern anatomy suitable for eShunt Implant deployment as confirmed by SSC (subject screening committee) Pre-procedure CT confirmation of no obstruction preventing CPA cistern access at target implant site (e.g., petrous bone) as confirmed by SSC Exclusion Criteria: Patient is in a state of unconsciousness or is unable to understand the information provided in the Informed Consent Form for this study Indication of obstructive hydrocephalus Presence of gross blood in CSF from EVD Pregnant Unwilling or unable to comply with follow up requirements Active systemic infection or infection detected in CSF Life expectancy < 1 year Hypersensitivity or contraindication to heparin or radiographic contrast agents which cannot be adequately pre-medicated, desensitized or where no alternative is available Occlusion or stenosis of the internal jugular vein Venous distension in the neck on physical exam Atrial septal defect or patent foramen ovale identified on cardiac echocardiogram History of bleeding diatheses, coagulopathy or will refuse blood transfusion in cases of emergency Clearly antecedent stroke unrelated to post-aneurysmal SAH Patient is currently participating in another investigational drug or device trial that could conflict with study data collection or follow-up Other medical illnesses that may cause the patient to be non-compliant with the protocol or confound data interpretation as determined by the study Investigator Presence of a deep vein thrombosis superior to the popliteal segment of the femoral vein International Normalized Ratio (INR) or Partial Thromboplastin Time (PTT) results outside of normal range (INR 0.8-1.4; PTT 25-35 secs.)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Prospective, single-center, open-label, single-arm pilot study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment Arm<br>The Treatment Arm receives the eShunt implant | Device: eShunt™ Implant<br>* The eShunt™ Implant is designed to drain excess cerebrospinal fluid (CSF) from the intracranial subarachnoid space (SAS) into the venous system as a minimally invasive treatment for communicating hydrocephalus.<br>* Other names: eShunt™ System;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reduction in intracranial pressure (ICP) | At 36-48 hours following eShunt Implant deployment and with EVD remaining clamped, an ICP assessment that demonstrates: 1) ICP below 20 cmH2O as measured by the EVD with no periods longer than 15 minutes above 20 cmH2O; and 2) No episodes of ICP, measured by EVD, above 25 cmH2O with associated subject symptoms | 36-48 hours following eShunt Implant deployment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of subjects requiring conversion to conventional CSF shunt | Evaluate the need for CSF diversion by conventional CSF shunt insertion within the 24 months following eShunt Implant deployment | 24 months following eShunt Implant deployment | 
| Incidence of clinically significant abnormal laboratory test results | Clinically significant changes from baseline laboratory test results will be summarized | 24 months following eShunt Implant deployment | 
| Incidence of clinically significant changes from baseline MRI imaging | Clinically significant changes from baseline MRI images will be summarized | 24 months following eShunt Implant deployment | 
| Incidence of clinically significant changes from baseline CT imaging | Clinically significant changes from baseline CT images will be summarized | 24 months following eShunt Implant deployment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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eShunt