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

July 26, 2011

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.

Explore further: Women with aortic aneurysms fare much worse than men, new study finds

Related Stories

Heart doctors repair coronary aneurysm without open surgery

February 16, 2012

(Medical Xpress) -- Methodist DeBakey Heart & Vascular Center interventional cardiologists have, for the first time, repaired a large coronary artery aneurysm with stent-assisted coil embolization without doing open heart ...

Recommended for you

Researchers identify brain network organization changes

May 25, 2017

As children age into adolescence and on into young adulthood, they show dramatic improvements in their ability to control impulses, stay organized, and make decisions. Those executive functions of the brain are key factors ...

Fathers' brains respond differently to daughters than sons

May 25, 2017

Fathers with toddler daughters are more attentive and responsive to those daughters' needs than fathers with toddler sons are to the needs of those sons, according to brain scans and recordings of the parents' daily interactions ...

Scientists demonstrate the existence of 'social neurons'

May 25, 2017

The existence of new "social" neurons has just been demonstrated by scientists from the Institut de neurosciences des systèmes (Aix-Marseille University / INSERM), the Laboratoire de psychologie sociale et cognitive (Université ...

How fear can develop out of others' traumas

May 25, 2017

What happens in the brain when we see other people experiencing a trauma or being subjected to pain? Well, the same regions that are involved when we feel pain ourselves are also activated when we observe other people who ...

Babies' slow brain waves could predict problems

May 25, 2017

The brain waves of healthy newborns – which appear more abnormal than those of severe stroke victims – could be used to accurately predict which babies will have neurodevelopmental disorders.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.