Brain :: Mayo Clinic offers latest technology to repair brain blood vessels

Surgeons at Mayo Clinic in Jacksonville, Fla., are adapting a common heart artery procedure to help people with life-threatening cerebral aneurysms — a bulge in brain blood vessels that can burst.

The surgeons are the first in the Northeast Florida area to use a stent as part of a procedure to treat brain aneurysms. Stents, which are tube-shaped mesh structures that fit snugly against the inside walls of a blood vessel, are often used within heart arteries to push plaque away from the vessel wall and improve blood flow.

These devices are now beginning to be used to treat other problems. At Mayo Clinic, surgeons are implanting these devices directly into blood vessels in the brain of patients with potentially devastating brain aneurysms.

“We have taken a big step forward in the treatment of cerebral aneurysms by using stents,” says neurosurgeon Ricardo Hanel, M.D., who came to Mayo Clinic this summer from the University of Buffalo, the center that developed the technique and was first in the world to use it. “This technique allows us to help many more people, particularly those with difficult aneurysms who may not have had many treatment options previously.”

An aneurysm – a bubble in a brain artery caused by weakness in the vessel wall – can strike any person at any time. It is estimated that up to 4 percent of the population has a cerebral aneurysm. The traditional way to treat a cerebral aneurysm is to surgically open the skull and use a clip to pinch the vessel walls back together, eliminating the bulge. “This is the gold standard treatment, but it requires open surgery and a longer recovery,” Hanel says.

It wasn’t until the mid-1990s that patients had a minimally-invasive option for treating aneurysms – coiling. With this procedure, surgeons insert a catheter into a patient’s groin and then deposit platinum coils directly inside the brain aneurysm. The coils coax a blood clot to form that seals off the bulge.

Unfortunately, there are limitations to using coils, says David Miller, M.D., an interventional radiologist at Mayo Clinic who has treated many patients with coils.

“Between 30 and 40 percent of aneurysms are wide-necked aneurysms, meaning the opening of the aneurysm is too wide to keep the coils in place. These cases usually require the use of clips – and invasive surgery,” he says.

Additionally, in a small number of patients, the coils simply do not stay in place and the aneurysm can recur.

“It is our hope that using the stent technique, more patients have the opportunity to forgo invasive surgery and receive coils,” says Hanel. The stents, which look like fine mesh wire, keep the coils inside the blood vessel and in the correct position. “Stenting also changes the dynamics of blood flow in the brain blood vessel, which further helps prevent the aneurysm from reappearing,” Hanel says.

The next big leap in treatment will be to use a covered or solid stent that can wall off the aneurysm bulge even in the smallest vessels. This technique is being used in Europe and is under study in the United States.

“We are hopeful that a stent will be available in the near future that will work alone, without the need for a coil,” says Hanel. “But today, thanks to the specialized training of our physicians in interventional radiology, neurosurgery and neurology, we have all the pieces in place to make Mayo Clinic in Jacksonville a premier center for cerebrovascular surgery,” Hanel says.

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