Centers of Excellence in Interventional Cardiology and Radiology

INTERVENTIONAL NEURORADIOLOGY

Cerebral aneurysm

The procedure performed by team of specialists from abroad!

Our center has saved the lives of over 4,500 patients in the last 4 years

The most modern equipped angiography room , an exceptional medical team

We have the most famous abroad specialists! Team from Romania, Israel, Greece and Germany!

Only 24 hours hospitalization

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Generalities

An aneurysm is an abnormal, weak spot on a blood vessel that causes an outward bulging or ballooning of the arterial wall. An aneurysm can affect any vessel in the body but only those in the head can cause a serious medical condition, a hemorrhagic stroke when they rupture, which can lead to brain damage and death or, a lerge aneurysm may press on brain tissues and nerves, possibly causing pain above and behind an eye, dilated pupil, change in vision or double vision, numbness, weakness or paralysis of one side of the face, drooping eyelid, headache.

Wath is the cause of Acerebral aneurysm ?

Cerebral aneurysms can be congenital, resulting from an inborn abnormality in an artery wall. Cerebral aneurysms are also more common in people with connective tissue disorders and polycystic kidney disease, and certain circulatory disorders, such as arteriovenous malformations (snarled tangles of arteries and veins in the brain that disrupt blood flow).

Other causes include trauma or injury to the head, high blood pressure, infection, tumors, atherosclerosis, cigarette smoking, and drug abuse.

Also, there are age-related (the average age at presentation is usually 40 to 60 years old).

How are aneurysms classified?

There are differents types of cerebral aneurysm: the most frequent is the saccular aneurysm (is a rounded or pouch-like sac of blood that is attached by a neck or stem to an artery or a branch of a blood vessel, this most common form of cerebral aneurysm is typically found on arteries at the base of the brain), while a fusiform aneurysm (spindle shaped) without a distinct neck – these are associated with atherosclerosis and disecant lesions – and, usually they are the result of truama with dissection/rupture of arterial of arterial wall, so the blood can accumulate into the notch created, with secundar ballooning of arterial wall.

Symptoms

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Most aneurysms are asymptomatic, particularly ones that are small (diameter under 10 mm) have a low risk of rupture, but this risk increased is releated with size (large aneurysms), with location ( posterior, at the base of the brain) or in case of history of ruptured aneurysms.

An aneurysm may evoluate for long time asymptomatic, and the first signs of his presence can be related with hemorrhage caused by his rupture ( subarachnoid hemorrhage – in the space between the brain and his covers or intracerebral hemorrhage – into the brain). In this case the patient may feel severe, sudden headache, nausea, vomiting, stiff neck, blurred or double vision, sensitivity to light, seizure, a drooping eyelid, loss of consciousness, confusion.

An unruptured brain aneurysm may produce no symptoms, particularly if it’s small. However, a large unruptured aneurysm may press on brain tissues and nerves, possibly causing: pain above and behind an eye, a dilated pupil, change in vision or double vision, numbness, weakness or paralysis of one side of the face, headache.

Diagnosis

Diagnosis is settled using imaging studies: angio-computer tomography, angio-magnetic resonance imagistic, cerebral angiogram. As we pointed above, there is genetic predisposition ( although is not inherited), so screening tests are recommendet, particullary for first-degree relative.

Indications

As we pointed above, cerebral aneurysms (particullary the large ones) are at high risk for rupture, causing cerebral hemorrhage, wich may injure the surrounding brain resulting in a stroke , with possible permanent disability or even death. Spontaneous healing is extremely rare, so treatment is needed. There are two common treatment options: surgical clipping or interventional treatment – wich is minimally invasive (endovascular coiling).

A neurologist and a neurosurgeon can help you determine whether the treatment is appropriate for you. Factors that they would consider in making a recommendation include:

you age and general health: for older peoples with others health problems interventional treatment may be more adequate.

aneurysm’s shape: interventional treatment is more proper for a sacular aneurysmm with narrow neck rather then one with long neck or one with unclear opening (unclear neck).

location: there are some location that make very difficult the intervetnional treatment

arterial anatomy of the head: sinuous arteries increase the difficulty of minimally invasive procedure.

We should also point that treatment is recommendet for both, ruptured and unruptered aneurysms.

Procedure

The interventional treatment (endovascular coling) is performed using a technique similar with angiography, under general anaesthesia and heparin and sometimes under light sedation .

A small cut (less than 1 centimetre) is made in the skin of your groin. Through this cut, the femural artery is punctured with a small needle and a catheter (long thin hollow plastic tube) is inserted into the artery.

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Very tiny catheters (microcatheters)are used; this catheters have a coil attached on their extremity and they are navigated through the blood vessels to the vessels of the brain and into the aneurysm. Then, using X-ray guidance, the endovascular surgeon carefully places soft platinum micro-coils (spirals of platinum wire) into the aneurysm and detaches them. The coils stay within the aneurysm and act as a mechanical barrier to blood flow, thus sealing it off.

The procedure may need to be performed more than once during the person’s lifetime.

Coils are platinum devices, extremely thins ( the thiny one has a thickness smaller than hair, and the biggest is 2 times than hair), very flexibles, witch block the aneurysm.

Through the catheter, serial angiograms are performed, checking the position of the catheter.

After endovascular coiling, a new angiogram is performed. If the aneurysm is “closed” then the doctor will apply a microcurent, detaching the coil.

When the procedure is done (either the total obstruction was achived, either there is nothing to do in this session) the catheters are removed.

Advantages of the interventional treatment:

• may reduced the aneurysm’s size so that the it can be suitable surgery

• no open surgical procedure

• short hospital stay

• decrease hemorrhagic risk and should be targeted to relieving symptoms

Is it painful?

The doctor may use general anesthesia, so the patient will not feel any pain, and after the procedure it will received pain drugs.

How long does it take?

Typically it takes 2 to 3 hours, but sometimes the procedure may last even 6 hours and is performed in the cath lab.

Risks

Complications are rare and the risk is decreased because the proper preparation and the permanent surveillance.

• damage to surrounding blood vessels, organs, or other structures by instruments

• puncture site infection or bleeding or arteriovenous fistula

• pain

• gaseous embolia

• allergic reaction from the general anaesthesia

• fever

• cerebral complications: stroke ot ischemic transitor atack, hemiplegia, loss of conscioness, aphasy

• puncture site hematoma

• bleeding, aneurysm’s rupture and stroke

• other possible complications include stroke like symptoms such as weakness in one arm or leg, numbness, tingling, speech disturbances and visual problems

• very low risk of death due to stroke, hemorrhage

• failure of procedure cause by anatomic or technique reasons

• after procedure, some patients may present sensibility of the scalp or temporary localised hair loss and sun sensibility.

Before procedure

The preop consult establishes if aneurysm can be treat using either the endovascular coling, either surgery. For this main, imagistic techniques are very useful (particullary angiogram).

Preadmission will be done one day prior to the embolization.

If you are on medication, your will discuss with you whether to continue with your medication and give you full instructions. In particular, if you have diabetes, kidney or thyroid diseases, or if you are on blood thinning (anticoagulant) medication, special instructions will be provided to you.

You will have a medical check up to ensure that you are fit for the operation and for the anaesthetic, to have any necessary blood tests performed, and to give you any information or any special medication that you may need to take before the embolisation procedure. You will also need to sign a consent form to give permission to treat you. You will be asked to fast for eight hours before the procedure, generally after midnight. If you are pregnant or suspect that you are pregnant, you should notify your health care provider.

Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).

After procedure

This is a minimally invasive procedure so the recovery is quick.

You may be taken to the intensive care unit and you will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. You will be given pain medication for incisional pain. Your doctor will instruct you to remain still, lying flat in bed for up to eight hours. This rest period allows the groin artery to heal.

You can leave the hospital after 1-2 days.

The surgical incision may be tender or sore for several days.Take a pain reliever for soreness as recommended by your doctor. You should not drive until your doctor tells you to. Other activity restrictions may apply, if needed. Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation. Check out for fever, pain or alteration at the incision plance, but also for neurologic events.

After the procedure, you will need to have follow up radiology tests such as magnetic resonance imaging (MRI) scans or angiograms to see how effective the procedure has been – usually, first time after few months (your doctor will tell you).

It is important for you to know that your aneurysm must be followed so repetead angiograms are needed – the first one, usually after at least one month (your doctor will discuss this with you).

Important!

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Do not forget that cerebral aneurysm, although in most cases is asymptomatic, involves a high risk of bleeding and untreated, these can lead to severe consueqences (including death) so treatment is needed, before severe complication may develop.

Endovascular coling is a minimally invasive procedure, efficient, with a quick recovery and short hospitalison.

DOCTORS
that perform the procedure

X

Sună Mesaj