The next-generation brain aneurysm repair

Vivek Deshmukh, M.D., FACS
Medical director, Providence Neurointerventional Services

Published November 2012

Earlier this year, a 41-year-old male presented with a history of severe brain injury caused by a motorcycle collision nearly four years earlier. The trauma had caused significant subarachnoid hemorrhage resulting from a tear in the internal carotid artery on the right side.

Because he was at risk for developing an aneurysm, the patient periodically underwent magnetic resonance imaging of his brain, along with magnetic resonance angiograms of the blood vessels.

The patient’s last MRA revealed that the tear in his carotid artery had indeed progressed into an aneurysm, and a catheter-based cerebral angiogram showed that the aneurysm was growing. It could not be treated easily with standard surgical clipping or coil techniques.

A new device broadens options
Most cerebral aneurysms develop at a very early age and grow over time, but some can be caused by severe head trauma that tears the normal artery wall. This type of aneurysm can be dangerous, and it carries a high risk for future bleeding, particularly if it is enlarging.

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Standard surgical techniques, such as clipping, carry a high risk of complications for these traumatic aneurysms. Newer, less invasive techniques such as coil embolization offer another option, but these dissecting aneurysms are not always amenable to coiling.

Fortunately, the U.S. Food and Drug Administration last year approved a new device that offers a third option for treating cerebral aneurysms. The Pipeline Embolization Device is a braided metal stent that reconstructs the blood vessel from the inside of the artery. Its mesh is more tightly woven than the typical stent, allowing it to completely block the aneurysm while still allowing blood to flow through the vessel unrestricted.

See video animation.

The device is delivered transfemorally with the patient under general anesthesia. After this procedure, patients typically spend one night in the hospital and are back to work in less than a week.

Just before Easter weekend, we successfully placed a single stent across our patient’s carotid artery aneurysm. This immediately decreased blood flow into the aneurysm. He spent two nights in the hospital before being discharged home at his neurologic baseline. He was able to have Easter dinner with his family and has since done well.

Although there can be risks to the procedure, preliminary results suggest that the stent is quite safe. Currently, it’s used for both traumatic aneurysms as well as the more common congenital type of aneurysm.

Stent reconstruction is the next generation of treatment for brain aneurysms. Surgeons at Providence Brain and Spine Institute were among the first in the Pacific Northwest to use this pioneering technology to benefit patients.

Clinical articles by Vivek Deshmukh, M.D.