New Aneurysm Treatment

Recently Approved Device Provides New Treatment Option for Aneurysms

Thanks to a new surgical technique, Diana West was able to go home the day after Cleveland Clinic neurosurgeon Shaye Moskowitz, MD, operated on an aneurysm in her brain.

Ms. West gradually was losing vision in her left eye and assumed it was due to cataracts. After she was referred to Cleveland Clinic’s Cole Eye Institute, physicians found the pressure on her optic nerve was caused by a large aneurysm – a balloon-like bulge in an artery – behind her eye. She was a perfect candidate for a recently approved surgical technique involving inserting a mesh stent, the Pipeline Embolization Device, into her carotid artery.

The device, approved in April 2011 by the Food and Drug Administration, is a flexible stent implanted directly into the carotid artery, the major vessel that supplies blood to the front of the brain. Cleveland Clinic was one of 10 centers in the United States and Europe that took part in a two-year clinical trial of the device.

The pipeline stent is an option for patients whose aneurysms are not suited for more traditional surgical treatments. It works by diverting blood flow away from the aneurysm, allowing the blood remaining in the aneurysm to clot. The procedure is recommended for patients with large or giant wide-necked aneurysms, which are difficult to treat.

The surgery, which took place in October, lasted about 30 minutes. Ms. West experienced some headaches, but they weren’t severe. “If we had treated her with surgical coiling, the procedure would have taken several hours,” says Dr. Moskowitz. “Also, the risk of the aneurysm coming back or filling again is much lower with the pipeline stent than with coiling. The fact that we don’t have to do anything with it is wonderful.”

Results from her follow-up appointment in February 2012 show the aneurysm is still blocked off and the swelling has diminished. While Ms. West’s vision in her left eye has not returned, her headaches are gone and she is functioning at full capacity with no new issues at all, says Dr. Moskowitz.

“She will have an MRI in the spring and we’ll discuss those results,” he says. “In fall 2012, about a year post-surgery, she will have a regular catheterization and full diagnostic angiogram.”

Dr. Moskowitz has now done 14 surgeries with the pipeline stent and more are scheduled. “It’s impressive. Follow-up in patients with pipeline stents show the vast majority doing very well and the aneurysm almost completely gone with no complications,” he says.

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