New Technology for Intracranial Aneurysms

An intracranial aneurysm can be defined as a thin sac that develops in the brain through the swelling of a weakened blood vessel. As the swelling increases, the wall of the blood vessel (aneurysm) becomes weaker and runs the risk of causing a stroke if it ruptures in the patient’s brain. Most patients who suffer from an intracranial aneurysm need vascular reconstructive surgery to prevent the aneurysm from rupturing.

Current treatments include open surgical clipping of an aneurysm, which is a highly invasive procedure that involves opening the patient’s skull. This is a risky procedure that has a 12% mortality/morbidity rate and patients are required to stay in the hospital for three or four days after the operation. A second form of treatment involves less invasive neurovascular techniques such as the occlusion of the parent blood vessel that the aneurysm developed from. However, this type of treatment runs the risk of causing distal cerebral embolism: the blockage of a blood vessel by a foreign object, a piece of somatic tissue, a blood clot, or an air bubble.

Dr. Demetrius Lopes (a neurosurgeon) and Dr. Thomas Grobelny (a neuroradiologist) from the Neurologic & Orthopedic Institute of Chicago recently performed the first minimally invasive neuroendovascular procedure with a system called the Cordis Enterprise Vascular Reconstruction Device. The patient was a 58 year old woman diagnosed with an aneurysm based on symptoms that included problems maintaining her balance and ringing in her ears.

Neuroendovascular surgery combines the use of an x-ray, catheters, and clotting agents to treat brain and spine diseases that affect blood vessels. Surgeons place catheters into damaged blood vessels and fill the vessels with clotting agents. The procedure is normally performed in a fluoroscopy room instead of an operating room.

The technique that was designed by Dr. Lopes and Dr. Grobelny involves filling the aneurysm (via a catheter) with coils to obstruct blood flow to the aneurysm. In addition to coils, stents (wire mesh) are placed in the blood vessel to maintain the position of the coils and reconstruct the weakened blood vessel. The purpose of this advanced procedure is to stop blood flow to the aneurysm and restore normal blood flow to the parent blood vessel in a minimally invasive way.

According to Dr. Lopes, this technique can be used to treat more types of aneurysms than other techniques (e.g. open clipping or artery occlusion) because it is currently the least invasive neurological procedure. In addition, this procedure obstructs the aneurysm, thereby preventing it from rupturing and bleeding into the brain. The rupturing of an aneurysm can cause a hemorrhagic stroke. Dr. Lopes also stated that in the past, even if a patient was diagnosed with an aneurysm, if they did not present any symptoms, surgery was not a recommended form of treatment because it was too risky and invasive. The Enterprise Vascular Reconstruction procedure allows neurosurgeons and neuroradiologists to use the patient’s circulatory system to place catheters into the parent blood vessel and obstruct the aneurysm without have to open the patient’s skull.

Video

There are no published journal articles about the procedure yet, but videos of successful coiling procedures can be viewed from the Neurologic & Orthopedic Hospital of Chicago.