Advanced diagnostics and treatments help decide
By Michal Obrzut, MD
Approximately 6.7 million people in the United States are estimated to have an unruptured brain aneurysm, and most don’t know it.
A brain aneurysm occurs when a blood vessel in the brain weakens and the vessel wall balloons out. Causes include high blood pressure, fatty deposits in the arteries, head trauma and congenital defects.
Fortunately, most of these aneurysms are small and do not require treatment. These are usually found incidentally during brain imaging for other conditions.
However, some 30,000 aneurysms will rupture each year, and about half of these cases will be fatal. That leads to the question, when do we treat an aneurysm.
Watchful waiting
Depending on its type, size and location, an aneurysm may merit a watchful waiting approach. The team of specialists at Weston Hospital developed a way to safely monitor patients with unruptured aneurysms who have no symptoms. The approach minimizes the use of a diagnostic test called a cerebral angiogram that has a rare risk of stroke.
We typically perform a noninvasive test called a magnetic resonance angiography, or MRA, for the initial evaluation, which is followed six months later with another MRA to determine if the aneurysm is growing. Depending on the growth rate observed, the patient may be followed with a yearly MRA.
An MRA allows the blood vessels and blood flow in the brain to be viewed with a high degree of detail. The Weston Hospital team uses an advanced 3 Tesla MRA that is stronger and more sensitive, enabling us to see smaller defects.
Innovative treatments
For unruptured aneurysms that require treatment, there are many more options today than in years past. Now the majority of patients can be treated endovascularly, avoiding open surgery. Endovascular surgery is performed from within the blood vessel using thin, long tubes called catheters to reach the site of the aneurysm.
We can insert tiny coils or use a mesh or wire tube to close off an aneurysm in a vessel wall, use a liquid bioadhesive to seal an abnormal or damaged vessel, and divert blood flow to prevent further harm. Weston Hospital was the first center in South Florida to use an advanced flow diversion device that reduces the risk of blood clots from forming.
The flow diverter has new shield technology that acts as a ‘cloaking device’ from platelets, a component of blood responsible for forming clots to stop or prevent bleeding. This allows us to reduce the use of blood thinners and lowers the risk of stroke.
In cases where a patient requires open surgery, the team at Weston Hospital may perform microsurgery using advanced imaging techniques. The procedure is called microvascular clipping, and it entails making a small incision in the scalp and placing a metal clip over the aneurysm to prevent blood from flowing into the aneurysm.
To learn more about neurological care at Cleveland Clinic in Florida, visit ClevelandClinicFlorida.org/Neuro or call (877) 463-2010.
Dr. Michal Obrzut is Section Head of Neurointerventional Radiology, Cleveland Clinic Weston Hospital.
