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Treatment for brain aneurysms without surgery

December 19, 2011 12:00:00 AM PST
Faith Mitchell enjoys what life has to offer. But it wasn't long ago her life took a scary turn.

After a nasty fall, painful headaches set in. A CT scan revealed an aneurism lodged behind her eye in a very deep part of the brain, a dangerous and almost inoperable spot.

Brain aneurysms are abnormal bulging of arteries. When they rupture, stroke, brain damage or death can follow. They're often discovered when it's too late and one in 15 people could develop them in their lifetime.

"I was really scared because I didn't know what to expect," Mitchell said.

When neurologist Dr. Scott Standard saw Mitchell's scans, he decided to use the newly Food and Drug Administration-approved Pipeline Embolization Device to remove her aneurysm.

"It's a revolutionary advance in terms of actually being able to reconstruct the blood vessels within the brain," Standard said.

Surgeons have traditionally removed a small section of the skull to go underneath the brain and clip the aneurysm. But with the Pipeline stent, everything is done through an artery in the leg.

"It allows blood flow to occur through the inside of the stent but also into the very small blood vessels around the aneurysm," Standard said.

Once inserted, the stent expands against the walls of the artery and across the aneurysm, cutting off blood flow. The blood remaining in the blocked-off aneurysm forms a clot which reduces the chance for it to grow or rupture.

Standard said the aneurysm will completely heal around the stent and completely go away.

Today, Mitchell has put her scare behind her.

"I'm getting stronger every day, feeling better every day," she said.

For now, the Pipeline stent is only FDA approved for certain types of complicated aneurysms.

The stent also cuts recovery time from six months to only 10 days.

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Background: A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. It often looks like a berry hanging on a stem. It can leak or rupture, causing bleeding into the brain. Brain aneurysms develop as a result of thinning and degenerating artery walls. Aneurysms often form at forks or branches in arteries where the vessel is weaker. Aneurysms can appear anywhere in the brain, but are most common at the base.

A ruptured brain aneurysm most often occurs in the space between the brain and the thin tissues covering the brain. A ruptured aneurysm quickly becomes life-threatening and requires prompt medical treatment. In about 30 percent of cases, ruptured brain aneurysms are fatal. Most, however, don't rupture, create health problems or cause symptoms. Such aneurysms are often detected during tests for other conditions.

Symptoms: A sudden, severe headache is the key symptom of a ruptured aneurysm. Additional signs include: nausea and vomiting, stiff neck, blurred or double vision, sensitivity to light, seizure, drooping eyelid, loss of consciousness and confusion. In some cases, an aneurysm may leak a small amount of blood, causing a sudden, severe headache. A more severe rupture almost always follows leaking.

An unruptured brain aneurysm may produce no symptoms. However, a large unruptured aneurysm may press on brain tissues and nerves, possibly causing pain above and behind an eye, a dilated pupil, vision changes, numbness, weakness or paralysis in one side of the face or a drooping eyelid.

Pipeline stent: The Pipeline Embolization Device received FDA premarket approval in April 2011. Stents in general led to good outcomes. They prop up the vessel wall and when the vessel lining grows over the stent, it strengthens. Older stents, because of their mesh construction, have not been successful at redirecting blood flow; blood can flow through the mesh.

The Pipeline stent provides a mesh so tightly woven that it redirects blood flow past the aneurysm so that the aneurysm can clot off and heal. The international success rate with this flow-diverting stent has been high: 90 to 95 percent of the aneurysms treated never came back.

The stent is 75 percent cobalt chromium and 25 percent platinum tungsten. It comprises 48 densely braided strands. It is customizable in that multiple devices can be telescoped together, one inside the next, for longer constructs.

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