Cerebral aneurysms are swelling in the blood vessels of the brain due to the weakening of its walls that causes a bulgy appearance. These aneurysms can burst and cause massive bleeding in the brain known as subarachnoid hemorrhage(SAH). If not treated in time, patients tend to bleed again, and few survive the disease. SAH is always an emergency because ruptured cerebral aneurysms continue to be a significant cause of death which can be significantly reduced if treated early. Rebleed due to re-rupture of aneurysm is a very important factor, which makes early treatment all the more important. With modern surgical and interventional (endovascular) techniques, most of the aneurysm can be treated with reasonable safety. In the previous era open Surgery was the only option of treatment. However, problems with surgery include invasiveness and trauma to normal brain parenchyma. Thankfully, nowadays most of these patients can be treated by a minimally invasive technique of Endovascular Coiling Of Aneurysms. In this treatment a microcatheter is placed from one of the leg arteries into the aneurysm, which is then occluded with coils (detachable platinum coils) to prevent repeat bleeding. This minimally invasive approach ensures minimal injury to the normal brain, with less complications, better outcome and shorter hospital stay. However, certain complex aneurysms cannot be treated by coiling and for these patients, a Flow Diverter device is used to repair a badly damaged blood vessel of brain. This intervention is an endovascular technique in which a cylindrical, metallic mesh stent is placed inside the blood vessel containing aneurysm to divert the blood flow from aneurysm Over time, the aneurysm heals, preventing any rupture. Although, Flow Diversion is among the most effective and the newest technology available for aneurysm treatment, the current generation of devices could only be placed in larger blood vessels of brain. A new generation of device has been launched (Pipeline Vantage from Medtronic corporation) which can be placed through thinner tube into small vessels of brain. The wires of the device are built in layers so that despite small size it is visible to the doctor on fluoroscopy. These devices are also coated with special material (Shield technology) which reduces chances of any clot formation and one can use less anti-platelet (blood thinning) drugs, improving the safety for the patient.
The first such device in India was used by Dr Vipul Gupta in Artemis Hospital Gurugram. The patient was a 48-year-old lady who had brain hemorrhage in few years back due to a ruptured aneurysm. The patient was treated by coiling in the emergency period by doctors at Artemis hospital and she made complete recovery. However because of the badly damaged blood vessel a small part of the aneurysm had to be spared which on follow up angiography started to grow again. Since the patient was at a risk of repeat hemorrhage and the aneurysm which had grown again was not possible to be treated by coiling, team decided to use a flow diverter. Since the aneurysm was on a small blood vessel doctors used the latest Pipeline Vantage device. The procedure was successful and patient made complete recovery. The thinner device which could be placed through smaller tubes made the procedure possible and safer. This device can be used to treat many more patients with complex brain aneurysms quite successfully using the modern generation flow diverter device.
( The author is Director, Neurointervention, Agrim institute for Neurosciences, Artemis Hospital New Delhi. Views are his own)
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