Posted by Cynthia (Cindy) Weiss (@cindyweiss) · Nov 3, 2011
A new treatment for brain Aneurysms
Kristi Coody had suffered migraine-like headaches for three months, but this time the pain was more intense. She lay down on the living room floor of her Orange City, Fla., home and let her girls play around her. Her husband found her there when he came home from work that evening.
“This headache was much different than before and lasted approximately 16 hours before it broke,” Coody recalls.
She started keeping a log of her headaches and realized the episodes had become more frequent, more intense and longer lasting than before. She talked to one of her doctors.
“When I was going over it with him, I realized that I’d had nine severe migraines within 14 days,” Coody says. She asked her doctor to order a CT scan “to see if something was going on.”
That proactive approach paid off. Within four hours of her initial CT scan, Coody found out she had an aneurysm, a life-threatening bulge in one of the blood vessels in her brain. Her aneurysm was about an inch in diameter. With two small children, Coody, age 40, wasted no time finding a solution.
Coody went online and researched medical centers with expertise in brain aneurysms. Mayo Clinic in Jacksonville, Fla., was at the top of her list and was a two hour drive away. Within a week, Coody met with a Mayo Clinic neurosurgeon who told her about a new device being tested to divert the flow of blood from an aneurysm and stop the ballooning of blood vessels. The device — known as a flow diverter — was available to patients at Mayo Clinic’s campus in Rochester, Minn., as part of a clinical study evaluating the new technology.
“It seemed like the right choice,” Coody says.
In January 2011, Coody and her husband traveled to Rochester for the minimally invasive surgery. Florida surgeons joined Rochester colleagues to operate on Coody.
“These new flow diverters have a tight mesh that covers about 35 percent of the aneurysm. When placed in the artery, the flow diverter forces the blood to flow around the aneurysm and helps it to dissolve into itself,” explains Rabih Tawk, M.D., one of a handful of specially trained neurosurgeons skilled to handle these types of procedures. Others within Mayo Clinic include neurosurgeon Giuseppe Lanzino, M.D., and neuroradiologist David Kallmes, M.D.
The new technique reduces the recurrence of aneurysms as compared to other endovascular procedures. Recovery time is shorter, too, because the device is implanted through a vein in the groin, eliminating the need for open surgery. Long-term results are promising. “Six months later, the images are showing the aneurysm is completely gone,” says Dr. Tawk.
“I had the procedure on a Monday, was released from the hospital on Tuesday and I flew home on Thursday,” says Coody. Four months after the procedure, an image of her artery showed the aneurysm had disappeared. This “definitely met my expectations — that the flow diverter would reduce the aneurysm in three to six months. To learn at four months it was successful — I’m overjoyed,” says Coody, who was the 27th patient enrolled in the clinical study and one of the youngest.
The new technique is recommended for people with difficult-to-treat brain aneurysms because of the size, location or previous failed treatments, says Dr. Lanzino. The treatment was approved by the U.S. Food and Drug Administration (FDA) in spring 2011.
In the course of Coody’s treatment, doctors found three smaller aneurysms. “There was only a 1 percent chance that the smaller aneurysms could rupture, but my concern was that if any did rupture, the likelihood of survival is only 40 percent,” says Coody.
Coody wasn’t willing to take the chance. In June 2011, physicians at Mayo Clinic’s campus in Jacksonville inserted two flow diverters and used platinum coils on the third aneurysm, customizing the treatment to each aneurysm. Mayo Clinic in Florida was one of the first facilities in the country to offer the flow diverter procedures after FDA approval.
“We suspect that in December, when my next imaging is scheduled, we will find the same results that we did from the larger one,” Coody says. Although she still has headaches, Coody says they are manageable, and she has the support of a team of doctors who continue to care for her and monitor her healing process.
“Mayo Clinic has definitely changed our lives,” she says. “When we came here they showed me all my pictures from CT scans and arteriograms and explained things in so much detail.”
Dr. Lanzino says it’s important for patients to consider all of their treatment options. Flow diverters have been used for five years around the world and studied at Mayo Clinic for two years. “We’re still building evidence on long-term results,” he says.
(This story comes to us from the Sharing Mayo Clinic print publication.)