Five years ago, Nancy Skoog-Edholm had no idea she had two brain aneurysms. Then she started to feel bad.
“I had a terrible headache,” she recalls. “I felt really weak. I took my blood pressure and it was really, really high. When a CT scan of his brain revealed the aneurysms, Skoog-Edholm, who has a strong family history of the condition – his grandmother, cousin and aunt all died of premature aneurysms 56 years old – was rushed by ambulance to Abbott Northwestern Hospital in Minneapolis.
At Abbott, Dr. Yasha Kayan, a neurointerventional radiologist, met Skoog-Edholm in the emergency room. He told her she would need to get a lumbar puncture to determine if his aneurysms had ruptured – a life-threatening situation. If blood was present in his cerebrospinal fluid, that would be an indication of a rupture.
The lab found that there was no blood in Skoog-Edholm’s spinal fluid, but they found that she had viral meningitis. This condition, although serious, was unrelated to aneurysms – but it did help alert doctors to their presence.
Since brain aneurysms often have few or no symptoms, it is not uncommon for them to be discovered during tests for unrelated health conditions. Because a ruptured brain aneurysm can be life-threatening, finding an unruptured one presents a rare chance to treat the disease before it becomes an emergency, Kayan explained: “A lot of patients end up considering it lucky that they went looking for something else and found an aneurysm.”
Kayan said Skoog-Edholm that because her aneurysms weren’t ruptured, she could wait for her meningitis to resolve before starting treatment. He explained that when she felt better, he filled her small aneurysm with a reelless invasive endovascular procedure developed in the mid-1990s. Kayan placed a series of flexible platinum coils in his smaller aneurysm that slowed blood flow and created a clot that allowed a new blood vessel to form. The procedure, which carries some level of risk of stroke, was successful and took around three hours.
Another treatment option
Kayan knew of another option he hoped to use on the larger Skoog-Edholm aneurysm – the Woven EndoBridgeor WEB device. It was on track for FDA approval but was not yet available.
The WEB device, Kayan explained, works “a little differently” from a coil procedure. Rather than inserting a bunch of little coils, the WEB is a single device, a mesh basket that pops out of the microsheath in a collapsed state and then pops open in a aneurysm like a flower, hugging its walls. While the coils sometimes fall out and pose a risk of stroke or hemorrhage, Kayan said, the WEB device remains in place: “It serves as an easier scaffold for a vessel wall.”
Because the WEB device works quickly and fills the artery more completely, Kayan said, patients benefit in several ways. “They have less time under anesthesia, less risk of clots forming on our devices and clogging of a normal cerebral artery. There is less risk of stroke. He thought Skoog-Edholm was a good candidate for the procedure.
When the FDA granted approval for the WEB device a few months later, Kayan called Skoog Edholm and told him the good news.
“I was thrilled to hear that,” Skoog-Edholm said. While the coil treatment for her first aneurysm went well, her recovery from the procedure took time. She was hoping for an easier result the second time around.
At Abbott, first choice
At Abbott Northwestern, Kayan and his neuro-interventional radiology colleagues now consider the WEB device their first choice for treating aneurysms. While Kayan said many medical practices still view WEB as a “much more niche device for specific situations,” he and his team see it as a game-changer that has improved the outlook for a wide range of patients. of aneurysm.
“We’ve used it in many different anatomy types,” he said. “The reason we do it is because it’s so safe compared to other techniques. With experience, we’ve found it works in a wide variety of situations.
Beyond the benefit of shorter surgical times (“You can walk in, drop a single device often in 30 or 40 minutes, and you’re done,” he said), Kayan added that the profile of security of the WEB device compared to that of the reels is also attractive. Whereas previously brain aneurysms had a 2-3% risk of stroke and the highest-risk aneurysms had a 5% risk of stroke, he said, “With the WEB device, the risk of ‘a major stroke is less than 1%’.
Brain aneurysm is more common than most people realize, Kayan said. He explained that each year, doctors discover about 30,000 brain ruptures aneurysms. But because most brains aneurysms don’t break up, he says, he and his colleagues work with patients to help them understand the risks and benefits of treatment.
“Some aneurysm we know the risk of rupture is low,” Kayan said. “With these, we’re saying the odds are low and it’s probably not worth having the treatment.” Patients at low risk of rupture are enrolled in the practice monitoring program. With patients at intermediate risk of rupture like Skoog-Edholm, they recommend treatment.
Back to normal
For Skoog-Edholm, the news that she had two brain aneurysms was chilling. “I was walking on eggshells,” she said. “I was constantly monitoring my blood pressure, always trying to protect myself.”
An avid rider, she said she kept her feet on the ground until procedures were completed for both aneurysms. While she needed to give herself more time to rest and feel better after her coil procedure, she said that after the WEB device was placed, she felt normal quickly and ready. to get back in the saddle.
“I’m back on my horse,” Skoog-Edholm said. “The procedure went so well. I felt less groggy and tired than with the first one. And the pain was minimal.
Since Skoog-Edholm’s risk of stroke or other side effects from these procedures is relatively low, Kayan has him undergo annual MRI scans to confirm that the aneurysms remain resolved. Other than that, she said she felt like this troubling chapter in her life was now closed.
“After I got my MRI,” Skoog-Edholm explained, “Dr. Kayan looks at it, and then he writes back to me with a letter. putting worries aside: “Often I don’t even think about it anymore. I’d much rather be on horseback.”