As Stephanie Weiss was coming to grips with the news she had two large and three small aneurysms in her brain, the Los Angeles independent travel consultant was told there was no minimally invasive way to treat at least one of the defects: a wide-neck aneurysm. She would have to undergo open-brain surgery.
But in a second consultation, with neurosurgeon Michael J. Alexander, MD, at Cedars-Sinai Medical Center, she learned about a new device - approved by the Food and Drug Administration just last April - that made it possible to close even wide-neck aneurysms like hers that were pressing against the optic nerves without the risks, pain and longer recovery of major surgery.
In a June 23 procedure that took less than two hours, Alexander sealed off the wide-neck aneurysm with the new device and stabilized the other large aneurysm with a conventional procedure called coiling - all accomplished by inserting a catheter and instruments into a blood vessel in the groin and guiding them into Weiss' brain.
"I've gone to a dentist and it's been more complicated," says Weiss, 58, who was on the phone with her office two hours after the Thursday procedure, spent one night in the hospital, cleaned and vacuumed her house on Sunday and went back to work on Monday.
Aneurysms, weak areas of arteries that balloon out, can have catastrophic brain-damaging and life-threatening consequences if they burst. With very small aneurysms, the risks of intervention may be greater than the chances of rupture; therefore, these may be monitored over time. For most aneurysms that pose a threat, two main treatment options exist: In an open-brain operation, surgeons may place a metal clip at the neck of the aneurysm to close it, or surgeons or neurointerventionalists may use the minimally invasive route to fill the aneurysm with platinum coils.
"Large and wide-neck aneurysms have presented a special challenge because the base of the 'balloon' is very broad. The coils would just pop back out of the aneurysm and potentially block the artery," says Alexander, professor and clinical chief of the Department of Neurosurgery and director of the Neurovascular Center at Cedars-Sinai. "In recent years, we've used stents - called vascular remodeling devices - to keep coils in the aneurysm and out of the artery, but the Pipeline device virtually eliminates the need for coiling in some cases and may be an option in instances where coiling has failed."
The tube-like Pipeline stent is placed in the artery to cover the aneurysm, maintain blood flow through the artery and provide a mesh scaffold for blood vessel cells to grow and form a permanent, stable seal.
Weiss, who had no known family history of aneurysms and no awareness of the five in her brain, went to an ophthalmologist in early March - her first visit to an eye doctor - to find out if she was a candidate for vision-correcting surgery.
"They examined me for about two hours and put me through all the tests, and the doctor said, 'Your eyes aren't that bad for your age, but your peripheral vision on both sides is gone. I want you to get an MRI,'" Weiss recalls, adding that she had not noticed a change but apparently compensated for the loss by turning her head.
The MRI showed two large aneurysms, one on each side of her head along the optic nerves, where coiling or open surgery may be risky because the procedures themselves can injure the nerves or put more pressure on them. When a follow-up CT scan came back, the first doctor Weiss consulted said, "The good news is I can do surgery. The bad news is you have five (aneurysms)." But open-brain surgery was the only option offered.
Alexander's approach was different, partly because after completing his neurosurgery residency he undertook one fellowship in cerebrovascular and skull base surgery and another in interventional neuroradiology, the use of sophisticated imaging systems and minimally invasive tools to treat brain conditions through blood vessel pathways. He had experience inserting the newly approved Pipeline device before Weiss came to him for help.
"With the Pipeline, we have already seen cases where the aneurysm not only is effectively treated, but the aneurysm may actually shrink away, taking pressure off the surrounding nerves and brain," Alexander notes.
Weiss says Alexander's experience and minimally invasive skills appealed to her.
"Dr. Alexander said, 'I do open-brain surgery and I do coiling, but my first choice is the less-invasive treatment. We can go in, fix what we can with coiling or stents, and we can always step up to open-brain surgery if we need to.' That's the kind of doctor I want, someone who's a little conservative," comments Weiss, who says much of her peripheral vision has returned: 90 percent on one side and 50 percent on the other.
Her last brain scans looked good, too, but if she ever needs to have one of the other aneurysms repaired, this experience put her mind at ease.
"If I have to go back in, if one of them is getting bigger, no big deal. It's like two days out of my life. Big deal. No fear whatsoever," she says.
Study: Obstructive sleep apnea may be a risk factor for abdominal aortic aneurysms