Non-Surgical Approach Showing Great Promise in the Treatment of Challenging Brain Aneurysms

(2005-09-04)

A fender-bender may have saved Douglas Collins' life. A CT scan following the accident discovered Collins, 64, had a brain aneurysm, a weakness in the arterial wall that if ruptured could cause a stroke or death. It was not caused by the accident, but likely could have been a ticking time bomb present for years. The aneurysm was large and previously thought to require open surgery and a lengthy recovery.

A second opinion brought Collins to Rush University Medical Center and Chicago Institute of Neurosurgery and Neuroresearch (CINN) neuroendovascular specialist Dr. Demetrius Lopes. Lopes recommended a new approach combining the use of intracranial stents and coil embolization to strengthen the artery with no need to open the skull. Dr. Lopes is one of the most experienced physicians in the world with this new technique.

"Obviously, why would I want to undergo a long recovery period if I don't have to," said Collins. "I chose to have Dr. Lopes perform the procedure and it was a complete success. I was back on the golf course within days."

Until recently, people like Collins with wide-necked aneurysms in the brain would not have been candidates for coil embolization, a procedure in which tiny coils are used to close off the aneurysm. To deliver the coils to the aneurysm, a catheter is inserted into the femoral artery, located in the upper leg, and threaded through the artery and into the blood vessels of the brain.

Historically, if the aneurysm was more than 4mm, the "wide neck" of the aneurysm prevented the coil from staying in place on its own and the aneurysm was very likely to return. The recent introduction of flexible intracranial stents has provided a method of preventing the coil from migrating out of wide-necked aneurysms. Therefore, more patients can undergo minimally invasive interventions to repair their cerebral aneurysms.

The initial treatment stage involves placement of the stent in the artery across the aneurysm neck. A microcathether is navigated through the stent struts into the aneurysm sac. The second stage consists of filling the aneurysm with coils. The stent works as a scaffold preventing the coils from migrating out of the wide neck aneurysm. The body responds by forming a blood clot around the coils and new tissue growth around the stent strengthening the weak spot in the artery.

A study by Lopes, published in the January issue of the Journal of Neurosurgery, found that in 90 percent of his patients, the stent-assisted coil resulted in complete closure of the aneurysm without compromising the parent vessel at least six months after the procedure.

"Our results are encouraging because they demonstrate that devices like the intracranial stent will continue to not only improve our ability to treat challenging wide-necked aneurysms without opening the skull but also to have a significant impact on re-treatment rates" said Lopes.

Coil embolization is currently used to treat approximately 30 percent of cerebral aneurysms. The procedure is less invasive and requires significantly less recovery time than open surgery for aneurysm repair. Additional benefits include minimal blood loss and the option for local anesthesia. Patients who did not have a ruptured aneurysm prior to treatment may be able to leave the hospital the day after the procedure and return to their normal routine within days.

Collins returned to the hospital four months after his procedure for additional tests to make sure there was no leakage. The results showed the stent-assisted coil embolization was a success.

"I am very pleased with the results," said Collins. "I have no limits and I'm enjoying life to it's fullest."

Rush University Medical Center is an academic medical center that encompasses the 600 staffed-bed hospital (including Rush Children's Hospital), the Johnston R. Bowman Health Center and Rush University. Rush University, with more than 1,270 students, is home to one of the first medical schools in the Midwest, and one of the nation's top-ranked nursing colleges. Rush University also offers graduate programs in allied health and the basic sciences. Rush is noted for bringing together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging.

The Chicago Institute of Neurosurgery and Neuroresearch is one of the nation's leading organizations for the diagnosis, treatment and rehabilitation of people with brain and spine disorders. Originally founded in 1987, CINN is the Midwest's largest team of neurosurgeons known for their pioneering treatments in minimally invasive techniques. Through a network of seven hospitals spanning two states, CINN treats more patients with brain tumors and spine disorders than any other physician group in Illinois.

http://www.rush.edu