In December 2013, Janet* was taken to Providence St. Joseph Medical Center in Burbank, California, following the sudden onset of what she described as the “worst headache of her life.” The 55-year-old resident of New York had a history of hypertension and also had suffered from frequent and severe headaches.
By the time she arrived at the hospital, Janet had lost consciousness and was having difficulty breathing. She also was “posturing,” a seizure-like movement of the limbs and/or torso that is often associated with a serious spinal or brain injury.
A CT scan and CT angiogram of her head revealed that a giant aneurysm on Janet’s left internal carotid artery had ruptured. An aneurysm is a localized weak spot in a blood vessel that balloons and sometimes ruptures. Because of the size and complexity of the aneurysm that had ruptured in Janet’s head, the decision was made to treat it in stages.
Stop the bleeding
Joseph T. Ho, M.D., Ph.D., is a neurosurgeon specializing in cerebrovascular and endovascular neurosurgery – the treatment of conditions that occur within the vessels of the brain or spine. Dr. Ho now practices at Southwest Washington Neurosurgery and Providence St. Peter Hospital in Olympia, Wash., but he was working at St. Joseph Medical Center when Janet was admitted.
The first stage of Janet’s treatment was to prevent the aneurysm from bleeding again in the short term by protecting the top – or dome – of it with coil embolization. This technique requires skilled hands to place small, soft metal coils within the aneurysm to help block the flow of blood into it.
The challenge of treating giant aneurysms with coil embolization is the increased risk of incomplete treatment of the aneurysm and the potential for another rupture to occur. Dr. Ho recommended that the coil embolization on Janet’s aneurysm be reinforced with a flow-diverting stent called the Pipeline Embolization Device, or PED.
Approved by the FDA in 2011, the Pipeline is intended to treat adult patients with giant or wide-necked brain aneurysms by redirecting blood flow. The PED is made of dense, closely-knit metal mesh, delivered through a catheter placed inside the blood vessel.
In Janet’s case, the stent was laid across the neck or opening of the aneurysm in the internal carotid artery, obliterating the aneurysm. Although her three-week recovery in the intensive care unit was extremely challenging, Janet made a full recovery. Remarkably, she was able to return to her home in New York where she lives independently – without any disability.
“The treatment of intracranial aneurysms is complex,” says Dr. Ho. “Their evaluation and treatment can require a combination of open surgical and endovascular considerations. The management of patients with ruptured aneurysms is even more complex and requires a multidisciplinary team of providers to give the patient the best chance of making an optimal recovery.”
If you develop the sudden onset of severe headaches or other neurologic symptoms, contact your medical provider or call 911 immediately.
*Patient’s name has been changed.