Adding a stent during minimally invasive surgery to repair aneurysms prevents recurrence

July 26, 2011 in Neuroscience

The addition of a simple stent can help prevent potentially lethal blood vessel bulges in the brain from recurring after they are repaired in a minimally invasive "coiling" procedure, according to new research by Johns Hopkins physicians. A report on the research, published in the July Journal of Neurointerventional Surgery, could make coiling a more viable option for the 30,000 people diagnosed with brain aneurysms each year in the United States, the investigators say.

Cerebral , abnormal outward pouching of blood vessels in the brain, are traditionally repaired by an "open" operation, in which surgeons remove part of the , cut into the brain to reach the affected blood vessel, and then place a metal clip on the vessel where it balloons outward to close it down. In the past several years, surgeons are increasingly repairing aneurysms through coiling, in which they thread a platinum wire into a small in the groin, push it through the body's network of to the bulging one, then pack the wire into the where a natural clotting reaction closes it off.

Though endovascular (through the vessel) coiling has significant benefits compared to clipping, such as a lower of infection and recovery times measured in weeks instead of months, it also comes with a significant drawback—recurrence of the aneurysm about a third of the time, says study leader Alex Coon, M.D., assistant professor of neurosurgery, neurology and radiology and director of endovascular surgery at the Johns Hopkins University School of Medicine. Traditional aneurysm surgery has a low recurrence rate of about two percent.

To avoid recurrence and the need for further surgery, some surgeons have experimented with insertion of a stent, or small tube, in the blood vessel near the neck of the aneurysm. The goal is to prop open the affected vessel so that more wire can be packed into the bulge.

To learn whether stents actually prevent recurrence or add complications, Coon and his colleagues looked at medical records of 90 people whose aneurysms were repaired by coiling at The Johns Hopkins Hospital between May 1992 and March 2009. A stent was used in a third of the operations.

After two years of follow-up, the researchers found that aneurysms recurred in more than 40 percent of patients who did not have stents. The recurrence rate in the stented patients was only about 15 percent, and stented patients had no more complications than those without .

Coon notes that surgery for aneurysms is becoming more common, and knowing what can prevent recurrence will help surgeons and patients make informed decisions about the choice of procedure.

"It's easy to treat someone's aneurysm, but can you treat it durably and make it last? We've now shown in our study that stenting—something that makes sense from an engineering perspective, a clinical perspective and a common sense perspective—truly works," he says.

Provided by Johns Hopkins Medical Institutions

not rated yet  

Rank not rated yet
Relevant PhysicsForums posts
  • A question about drug tolerance
    createdMay 23, 2012
  • Poor nutrition leading to overeating?
    createdMay 23, 2012
  • Math and dyslexia?
    createdMay 21, 2012
  • portable metabolism meter?
    createdMay 21, 2012
  • Rare medical conditions on 20/20 tonight
    createdMay 18, 2012
  • "Good" Cholesterol in Doubt
    createdMay 17, 2012
  • More from Physics Forums - Medical Sciences

More news stories

Of mice and mental models: Neuroscientific implications of risk-optimized behavior in the mouse

(Medical Xpress) -- Regardless of an organism’s biological complexity, every encephalized animal continuously makes under-informed behavioral choices that can have serious consequences. Despite its ubiquity, ...

Neuroscience created 1 hour ago | popularity not rated yet | comments 0 | with audio podcast feature

Persistent sensory experience is good for aging brain

Despite a long-held scientific belief that much of the wiring of the brain is fixed by the time of adolescence, a new study shows that changes in sensory experience can cause massive rewiring of the brain, even as one ages. ...

Neuroscience created 22 hours ago | popularity not rated yet | comments 0

Boundary stops molecule right where it needs to be

A molecule responsible for the proper formation of a key portion of the nervous system finds its way to the proper place not because it is actively recruited, but instead because it can't go anywhere else.

Neuroscience created 22 hours ago | popularity not rated yet | comments 0 | with audio podcast

Locating ground zero: How the brain's emergency workers find the disaster area

Like emergency workers rushing to a disaster scene, cells called microglia speed to places where the brain has been injured, to contain the damage by 'eating up' any cellular debris and dead or dying neurons. ...

Neuroscience created 22 hours ago | popularity 5 / 5 (2) | comments 0 | with audio podcast

Genetic 'reset switch' enables signaling pathway to induce multiple developmental outcomes for olfactory neurons

Within the nervous system, a handful of signaling pathways modulate development of a cornucopia of different neuronal subtypes. “Even small alterations in neuron differentiation pathways can disrupt subsequent ...

Neuroscience created May 24, 2012 | popularity not rated yet | comments 0


Physicians definitively links irritable bowel syndrome and bacteria in gut

An overgrowth of bacteria in the gut has been definitively linked to Irritable Bowel Syndrome in the results of a new Cedars-Sinai study which used cultures from the small intestine. This is the first study to use this "gold ...

Phone contact with nurses linked with better outcomes for women with gestational diabetes

Among women with gestational diabetes mellitus, referral to a telephone-based nurse management program was associated with lower risk of high baby birth weight and increased postpartum glucose testing, according to Kaiser ...

Questionable research practices surprisingly common

(Medical Xpress) -- Not all scientific misconduct is flat-out fraud. Much falls into the murkier realm of “questionable research practices.” A new study finds that in one field, psychology, these practices are surprisingly ...

Researchers identify key brain cell in antidepressant action

(Medical Xpress) -- Antidepressant medications such as Prozac have helped improve mood and lessen anxiety in millions of people with major depression. But scientists know surprisingly little about how these drugs work.

Routine care for Crohn's disease in children should include measurement of bone age

(Medical Xpress) -- Measuring bone age should be a standard practice of care for pediatric patients with Crohn’s disease, in order to properly interpret growth status and improve treatment, according to a new study from ...

Rockefeller scientists pioneer new method to determine mechanisms of drug action

(Medical Xpress) -- Knowing that a drug works is great. Knowing how it works is a luxury. And until now, determining a drug’s mechanism of action has been a tedious and difficult process for scientists.