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A STROKE OF LUCK FOR ANEURYSM PATIENTS

What is an aneurysm? Neuro Endovascular Specialist Dr Andrey Lugovsky of the Neuro Spinal Hospital answered that question: A brain aneurysm is a congenital disease that affects the brain. An aneurysm is small bubble that forms on the wall of an artery that carries blood to the brain. The aneurysm has a thin wall, which can easily break and cause bleeding into the brain. Another name for brain aneurysm is cerebral aneurysm.

A rupture is the worst-case scenario that leads to bleeding in the brain, called subarachnoid haemorrhage, the deadliest form of stroke. However, even before they rupture a cerebral aneurysm can be fatal-15 per cent of all victims die within minutes. The number rises to 50 per cent within a month if left untreated.

In Europe, for every 100,000 population, there are 27 cases of aneurysms. There are no statistics available to state an estimate in the GCC countries. In India and in China, the number is a little less.

Dr Andrey Lugovsky told City Times that till 1994, surgery was the only option for treating bleeding brain aneurysms.

"That is with an intervention in the brain. Aneurysms in the brain were corrected by a tiny metal clip placed across the neck of the aneurysm to stop blood flow into the aneurysm. This required removing part of the skull because the clip had to be placed from outside the blood vessel," said Dr Lugovsky.

Now there's a newcomer to the scene - Endovascular Coiling.

On April 7, Dr Andrey Lugovsky performed the first endovascular coiling technique in the UAE, filling the anterior communicating artery aneurysm with the tiny platinum coil. The patient was discharged few days later. He was transferred to Dubai from another GCC country and was not in a very good shape at arrival.

"This method treats the aneurysm from inside the blood vessel. Offered since April at the Neurospinal Hospital this technique is a minimally invasive procedure that uses a microcatheter and very thin platinum coils. The microcatheter - a tiny, flexible tube - is navigated through the blood vessels of the body starting from the groin all the way up to the brain, where the aneurysm is located. Once the microcatheter is inside the aneurysm, soft thin platinum coils are placed through the microcatheter into the aneurysm. The aneurysm is then filled with these coils until it is plugged up, thereby preventing any further bleeding," said Dr Lugovsky.

The microcatheter is guided by real-time X-ray technology called fluoroscopic imaging that allows the physician to visualise the patient's vascular system and treat the disease from inside the blood vessel. Everything is done through a small incision, about four to five millimetres, made in the region of the groin.

Dr Lugovsky said that both surgery and coiling are methods used to prevent the aneurysm from breaking or rupturing.

"But endovascular coiling represents a great advance in treating cerebral aneurysms," said Dr Lugovsky, "What it really means is that prior to this you didn't have a choice of how to treat aneurysms. Now there is a choice."

The coiling procedure usually takes about two hours and requires overnight observation. Patients can usually go home the next day, which is a shorter recovery time when compared to surgery. It is important to treat aneurysms that have bled as soon as possible.

"This is not like a magic bullet," warned Dr. Lugovsky. "Not all aneurysms are amenable to coiling."

He said to get the best treatment patients should go to a hospital that offered both coiling and surgery and be advised about both. The neurosurgeon and interventional specialist complement each other and together can provide the best course of action for the patient.

"Some aneurysms are better off being clipped," says Dr. Lugovsky.

Endovascular coiling was brought to the forefront of aneurysm treatment in 2002 after the completion of a multi-centre randomised clinical trial comparing surgical clipping to endovascular coiling.

This trial, called the International Subarachnoid Aneurysm Trial (ISAT), found that in patients equally suited for both options, coiling produced a substantially better patient outcome than surgery in terms of survival free of disability at one year (the relative risk of death or significant disability at one year for patients treated with coils was 22.6 percent lower than in surgically-treated patients).

The study was stopped early, after its steering committee determined it was no longer ethical to randomly assign patients to surgery and not give them the benefit of coiling. In the study, 1,073 patients were dedicated to coiling and 1,070 to clipping.

Long-term follow-up will be essential to assessing the durability of this new coiling technique. However, at least now patients have the choice.