ntracranial aneurysms can be lethal. The
survival rate following rupture of a cerebral aneurysm is only 50%, and one-third of survivors experience serious neurological damage. Although aneurysms mostly occur singularly, approximately 20 percent of all patients have multiple aneurysms.
Aneurysms are balloon-like sacs that form in weakened areas of arteries that bring blood to the brain, and can rupture. The intracranial bleeding that results can cause immediate death. Sometimes, aneurysms are inoperable, due to their location, anatomy, or the patient’s general medical condition. If untreated, there is a strong possibility that the patient will suffer another hemorrhage - with a significant fatality rate.
Until l996, aneurysm clipping was the approved treatment of intracranial aneurysms. But clipping required a craniotomy - the surgical opening of the skull by a neurosurgeon. A major surgical procedure, many elderly patients and those in poor medical condition were not always good candidates for craniotomies. Instead, they were medically managed through non-surgical methods, which were largely ineffective — resulting in a 60%
Now in Winthrop’s Institute for Neurosciences, interventional neuroradiologist A. Orlando Ortiz, MD, MBA, Chairman of the Department of Radiology, provides an FDA-approved neuroradiologic intervention for medically appropriate patients. Dr. Ortiz utilizes the Guglielmi Detachable Coil (GDC) system to localize and obliterate the aneurysm.
After comprehensive trials at major American medical centers, the GDC technique was FDA-approved in September, l995, and has gained wide acceptance. Patients receiving this intervention, described as endovascular electrothrombosis, have displayed far less rebleed rates and have improved rapidly.
The intervention is most effective when used on aneurysms described medically as “giant” and “symptomatic.” It is also expected to be very helpful to patients who have suffered a hemorrhagic stroke, dramatically reducing the likelihood of a second neurological event.
Who is Most Likely to Suffer
From an Aneurysm?
The answer is that it could be anybody. Dr. Ortiz
noted that some people are predisposed from birth to develop aneurysms. The development of high blood
pressure further aggravates the predisposition,
tipping the balance into the dangerous territory of potentially lethal intracranial hemorrhages.
Unfortunately, few people undergo CT and MRI brain scans until there is a medical emergency. An aneurysm rupture usually begins with what has been described as “the worst headache of one’s life.” Nausea, dizziness, vomiting, confusion, numbness, visual deficits, and loss
of consciousness are among the sentinel symptoms of
an aneurysm, which can occur during sleep as well as
Today, the standard diagnostic technique to identify aneurysms is the CT Scan, which immediately displays a subarachnoid hemorrhage. Some aneurysms are detected during angiography and MRI scans, as part of a diagnostic work-up for unexplained, excruciating headache pain.
Winthrop’s Institute for Neurosciences relies upon a team approach. Patients are often referred by their neurosurgeons, who are closely involved in the decision-making process leading to an intervention. Other practitioners include technologists, radiologists who interpret CT
scans and MRI studies, radiology nurses, and recovery room nurses.
Dr. Ortiz begins by introducing the specially designed microcatheter — a tiny, flexible tube — through femoral arteries in the groin. The microcatheter is advanced through the vessels, finally reaching the narrow, winding blood vessels leading to the base of the brain. Utilizing fluoroscopy to view the microcatheter’s progress on a monitor, Dr. Ortiz carefully advances the microcatheter into the aneurysm sac.
Dr. Orlando Ortiz reads brain scans.
The Guglielmi Detachable Coil, made of soft platinum, is advanced through a delivery wire that has been threaded through the microcatheter, and deployed into the aneurysm. The platinum coil is radiopaque, enabling Dr. Ortiz to visualize its position. He places it precisely — and safely — in the aneurysm sac. Only then is a continuous low-voltage electrical current applied through the system, separating the coil from the delivery wire, and releasing the coil inside the aneurysm.
This represents the “detachment” aspect of the GDC system - the electrolytic breaking off of the coil, followed by its deployment into the aneurysm.
A “Basket” of Platinum Threads
The detached coil expands, releasing its flexible threads, which wrap around inside the weakened area of the vessel, occluding the aneurysm. As needed, Dr. Ortiz releases additional coils of appropriate size, creating a dense “basket” of platinum coils. The threads conform to the often-irregular shape of intracranial aneurysms.
The coil resembles a rapidly developing microscopic ball of platinum - like a ball of yarn or knitting wool, filling the aneurysm and preventing rupture.
Once the aneurysm is occluded, the microcatheter is slowly withdrawn. Immediately after the procedure, a follow-up cerebral angiogram is performed to measure the procedure’s success.
Every aneurysm is unique, which is why the GDC intervention requires at least an hour of preparation. The GDC treatment of even the smallest aneurysm can take up to three hours. Treatment for larger aneurysms might require five to six hours.
“By l996, approximately 1,200 patients, worldwide, had been treated with the GDC,” said Dr. Ortiz. “The number of success stories is substantially greater today, and now includes Winthrop’s patients.”
For further information about the Guglielmi Detachable Coil system and procedure, please call Dr. Orlando Ortiz at (516) 663-2123.