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 aneurysms, abnormal outward pouching of blood vessels in the brain, are traditionally repaired by an "open" operation, in which surgeons remove part of the skull, 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 incision in the groin, push it through the body's network of blood vessels to the bulging one, then pack the wire into the bulge where a natural clotting reaction closes it off.
Though endovascular (through the vessel) coiling has significant benefits compared to clipping, such as a lower risk 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 stents.
Coon notes that endovascular 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.
Other Johns Hopkins researchers who participated in this study include Geoffrey P. Colby, Alexandra R. Paul, Martin G. Radvany, Dheeraj Ghandi, Philippe Gailloud, Judy Huang, and Rafael J. Tamargo.
For more information, go to:http://www.hopkinsmedicine.org/neurology_neurosurgery/
Christen Brownlee | EurekAlert!
A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital
Stem cell transplants: activating signal paths may protect from graft-versus-host disease
20.04.2017 | Technische Universität München
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
Two researchers at Heidelberg University have developed a model system that enables a better understanding of the processes in a quantum-physical experiment...
Glaciers might seem rather inhospitable environments. However, they are home to a diverse and vibrant microbial community. It’s becoming increasingly clear that they play a bigger role in the carbon cycle than previously thought.
A new study, now published in the journal Nature Geoscience, shows how microbial communities in melting glaciers contribute to the Earth’s carbon cycle, a...
20.04.2017 | Event News
18.04.2017 | Event News
03.04.2017 | Event News
21.04.2017 | Physics and Astronomy
21.04.2017 | Health and Medicine
21.04.2017 | Physics and Astronomy